Highlights

• SNAP Benefits Cliff
• Guardians for Unbefriended
• HiSET Now Free
• Behavioral Health Centers to Include Recovery Coaches and CHWs
• Financial Help for Women with Cancer
• Realities of Housing Vouchers

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues

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

As in previous years, the MA Department of Public Utilities (DPU) has extended the winter moratorium of low income residential terminations to April 1, 2023.

By statute it lasts until March 15 each year, but generally is extended each year to at least April 1.

Reminder that the Winter Moratorium applies to gas and electric needed to run heat- it does NOT apply to “deliverables” – oil, kerosene, coal, propane, wood, etc. 

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

It is important to note that shut-off protections do NOT eliminate the debt. Utilities may shut-off if/when protection ends if debt remains. Utilities may also send the account to a collection agency even if the account is protected from shut-off, which would also impact the consumer’s credit rating.

We encourage those with utility debt to consider applying for LIHEAP, and contacting their utility to see if they may qualify for an Arrearage Management Program – programs that forgives debt over time if the consumer begins to pay in-full and on-time going forward.

- Adapted in part from Winter Moratorium Extended to April 1, Anna Kowanko, NCLC, February 22, 2023

As reported last month, the extra COVID Supplemental Nutrition Assistance Program (SNAP) benefits, known as SNAP Emergency Allotments are ending with the February 2023 payment. This means that households will receive their last Emergency Allotment payment on March 2, 2023. A family’s benefit would then revert to a calculation that may reduce the benefit depending on family income, minus certain allowed expense deductions.

Mass Law Reform Institute (MLRI) has created a FAQ for Older Adults on Maximizing SNAP by Claiming Healthcare Costs. The document advises older adults and persons with disabilities about the loss of the extra SNAP and also how to claim health care expenses to maximize their SNAP benefits. This flier is also being translated into Spanish. 

- From MA Anti-Hunger Org Briefing on End of Extra SNAP; DTA Twitter Storm, DTAConnect Changes,  Pat Baker, MLRI,  February 17, 2023. 

Instacart is expanding its services to SNAP recipients. One of the ways Instacart is helping SNAP recipients is by extending its discounted Instacart+ membership.

Anyone who uses an Electronic Benefit Transfer (EBT) SNAP card to purchase groceries on Instacart is also eligible for a discounted Instacart+ membership, which is $4.99 per month, or 50% off. This allows users to have free delivery or pickup on orders over $35, 5% credit back on pickup orders and reduced service fees.

Note that any delivery or service fees cannot be charged to SNAP so households would need a second payment method.

“As grocery budgets tighten for millions, research has shown that access to online grocery and delivery can help families with lower incomes save time, reduce transportation costs, and more effectively manage their budgets,” according to a blog post by Instacart Chief Corporate Affairs Officer Dani Dudeck. “SNAP recipients who grocery shop online also purchase more fruits and vegetables than in-store shoppers, without increasing their total grocery bill, according to the research.”

- See the full MassLive article.

In late January, the town of Concord got a piece of news that quickly spread through the affluent community: The state had entered into an agreement with a local hotel, and would be setting up an emergency family shelter for homeless and migrant families in need of a place to stay.

The hotel, situated between Route 2 and the Assabet River, may signal what’s coming for other communities in a state experiencing a swell of migration, an acute shortage of affordable housing, and a growing population of homeless people — all of which combine to stretch the government’s shelter system to a breaking point.

The Department of Housing and Community Development, which manages the state’s emergency assistance system, intends to rent all 105 hotel rooms on an annual basis, with the first lease beginning March 1, the agency told the Globe. The hotel will host families for three to five days, but the agency will consider using a portion of the rooms for longer-term placements.
Statewide, there are only 3,600 shelter units in place; the Concord area, specifically, faces a critical shortage. Meanwhile, the median rent for a two-bedroom apartment in Concord is $3,250, according to Zillow.

There are 98 shelter sites and 14 motels or hotels operating as family shelters statewide, according to the agency, but there are plans to continue opening new sites, as the existing family shelter system has effectively reached capacity.

The state has made similar moves in other communities as it tries to meet the growing demand for shelter. Last fall, officials from Plymouth and Kingston complained that the Baker administration had failed to give them advance warning before placing migrants and homeless families into hotels in the South Shore communities. Before the move to the South Shore, many families were staying at a hotel in Methuen. More recently news broke that state officials and a Newton developer are having “early conversations” about using a vacant hotel as a temporary shelter for families

Massachusetts has a legal obligation to immediately provide emergency shelter to homeless families due to a 1983 “right-to-shelter” law, the only state in New England with such a requirement. State officials are scrambling to add to the shelter system to avoid running afoul of the law.

“With our Emergency Assistance system currently at capacity, our administration is unfortunately having to turn to motels to accommodate demand,” Governor Maura Healey’s office said in a statement, noting that the administration is committed to communicating with cities and towns when a new shelter is opening.

The arrival of thousands of migrant families and the rise in homelessness swamped the state’s emergency shelter system last year, forcing the Baker administration to place families in hotels. There were more than 200 families housed in hotels in November — a number that has more than doubled since the start of the year. As of Tuesday, 473 migrant and homeless families were living in hotels, according to state figures.

House and Senate leaders declined to advance funding, proposed by Baker toward the end of the legislative session, to shore up the shelter system.

This year, Healey proposed a supplemental budget that includes $85 million to support the emergency assistance program for families in need of shelter. The proposal also includes $9.5 million to maintain a temporary central intake center where families can receive a variety of services, including immigration-focused case management and health checkups. This central intake center is located at a community center in Devens, but it will wind down operations this spring. State officials said the funding can be applied to the Concord facility, which would evolve into a central intake facility.

- See the full Boston Globe article.

A pilot program, Public Guardian Services, is part of an ambitious initiative aimed at addressing an urgent and growing problem in Massachusetts: legions of people who are unable to make medical decisions for themselves but have no family members or friends willing or able to step in. Some of these individuals contribute to hospital crowding, because they have no one to sign off on a prompt discharge to a nursing home or rehabilitation center.

Lawyers and advocates estimate there are at least 3,000 “unbefriended” people in the state — most are older adults, though some are younger with brain injuries, intellectual disabilities, or mental health problems in need of a guardian. Massachusetts has had no central agency to handle these cases, nor a registry to track them.

“We are trying to show that we can improve the quality of life for people who have nobody,” said Wynn Gerhard, board chair of the nonprofit and a former senior attorney with Greater Boston Legal Services.

Another goal: providing a three-county model (Suffolk, Norfolk and Plymouth Counties) of what could be done cohesively on a statewide level, Gerhard said.
The state is also pursuing a project it hopes will provide a better handle on the burgeoning problem.

In October 2021, the Probate and Family Court was awarded a nearly $1 million federal grant to create a statewide Office of Adult Guardianship and Conservatorship Oversight.

Evelyn Patsos, the court’s deputy legal counsel and project director, said a top priority is to create a system that will reliably monitor what they believe are thousands of current guardianship cases that have been appointed by, or requested from, the courts.

“We have anywhere from 23,000 to 35,000 guardianship cases in Massachusetts, just on adults,” Patsos said. “That ranges because we are trying to see if any have passed away.”

With some instances of alleged financial and other forms of abuse in elder guardianships grabbing headlines, the state’s initiative aims to keep a close eye on cases.

One major goal of the new office includes creating a formal oversight system to regularly monitor guardians and ensure they are operating responsibly as well as establishing a state ombudsman program for families or other state agencies that have problems or may want to refer a case to protective services if they feel a guardian is not acting in the best interests of a client.

“We are bringing more staff to assist in this because it’s a huge endeavor,” Patsos said.

Fueling the problem is that often people fail to complete a health care proxy form, a simple document that designates a representative to make health care decisions for a person if he or she is incapacitated. Many other states have laws that allow someone else, such as a spouse, friend, or other family member, to make medical decisions when a proxy is missing — a law that, Patsos said, could ease the flood of guardianship petitions if it were enacted in Massachusetts.

A December survey by the Massachusetts Health and Hospital Association of administrators at three dozen hospitals revealed more than 150 people languishing in their beds, some for as long as 195 days, waiting for a guardianship or related conservatorship (to handle a person’s finances) to be finalized or expanded.

Brandon Saunders, whose law firm handles most of the new guardianship petitions in Eastern Massachusetts — they filed about 850 just last year and most involved hospital patients — said they struggle to find guardians because even those appointed by a court generally do not get paid.

“Reliance on volunteers to handle the bulk of the need for independent guardians in this Commonwealth is neither sustainable nor fair,” he said.

Pending legislation in Massachusetts aims to address that concern. The proposal (SD.698/HD.1727) would allow “reasonable” state-funded compensation for medical care-related duties of guardianship by professionals and extended family members. (Extended family is defined as those who are not a spouse, parent, grandparent, child, grandchild or sibling of the person needing a guardian.)

- See the full Boston Globe article.

The United States could bar tens of thousands of migrants arriving at the U.S.-Mexico border from claiming asylum under a new proposal that would be the most wide-ranging attempt yet by U.S. President Joe Biden's administration to deter unauthorized crossings.

Under the new rules, migrants who do not schedule an appointment at a U.S. border port of entry or use humanitarian programs available to certain nationalities would be ineligible for asylum except in certain cases. They must also first seek and be denied protection in countries they pass through to be able to claim asylum once in the United States.

The measure, which was posted online, will be subject to a 30-day public comment period before being reviewed for final publication.

Biden initially pledged to restore asylum access that was curtailed under his Republican predecessor, Donald Trump. But advocates and some fellow Democrats have criticized him for increasingly embracing Trump-style restrictions as he has struggled to cope with record numbers of arriving migrants.

Biden's plan to ban certain asylum seekers mirrors similar efforts under Trump that were blocked by federal courts and has drawn similar opposition.

The American Civil Liberties Union (ACLU) vowed to fight the Biden rule in court, comparing it to the Trump restriction, which was dubbed a "transit ban" by activists.

"We successfully sued to block the Trump transit ban and will sue again if the Biden administration goes through with its plan," said Lee Gelernt, the ACLU attorney who argued the Trump-era lawsuit.

Families and single adults would be subject to the restrictions while unaccompanied minors would be exempt, according to the rule, issued jointly by the U.S. Department of Homeland Security (DHS) and U.S. Department of Justice (DOJ). The measure would be temporary and limited to a period of two years, with the possibility to extend it.

Karen Musalo, director of the Center for Gender and Refugee Studies at the University of California College of the Law, San Francisco, said the Biden proposal ignores dangerous conditions and limited asylum capacity in transit countries where migrants will be expected to seek protection.
"It's a terrible example of trying to flout your domestic and international legal obligations," she said.

The Biden administration began discussing the ban and other Trump-style measures last year as a way to reduce illegal crossings if COVID-era restrictions allowing many migrants to be expelled back to Mexico ended. The administration is moving ahead with tougher asylum rules as the COVID restrictions, known as Title 42, appear likely to sunset on May 11 when the COVID-19 public health emergency terminates.

Biden expanded Title 42 in January to expel additional nationalities while allowing some people from those countries to apply for legal entry by air via humanitarian parole if they have U.S. sponsors. The parole program, for up to 30,000 Cuban, Haitian, Nicaraguan and Venezuelan migrants per month, would be one of the legal pathways the administration says would allow asylum-seekers to circumvent the proposed restrictions. But Parole too has been criticized for requiring a passport, a U.S. sponsor, and a plane ticket, as well as not offering a path to asylum/permanent residency. 

Separately, migrants seeking asylum at the U.S.-Mexico border could schedule an appointment at a U.S. land port of entry using an app called CBP One. But since the CBP One effort launched in January, migrants say slots have filled up quickly.

- See the full Reuters article.

Adult learners earning their high school credentials in Massachusetts can now take the high school equivalency exam for free.

The state has been covering the cost of the General Educational Development exam, or GED, since fall of 2022. Beginning this month, the Department of Elementary and Secondary Education (DESE) started covering the cost for the state's other recognized option, known as the High School Equivalency Test, or HiSET, according to a news release.

While classes for adult learners are free, earning the full high school credential requires that students pass a battery of tests, which could cost up to $143 per test, according to DESE. Officials say the goal is to remove the financial barriers for adults.

"You can imagine that there are some folks who forgo the tests for other basic needs," said Cliff Chuang, Massachusetts' senior associate commissioner of education. "This really is going to help remove that barrier and not be the reason someone is not getting the credential."

In 2021 about 9,000 adults in Massachusetts took a high school equivalency test. State education leaders hope that number will increase now that this additional cost barrier has been removed.

- See the full WBUR story.

In last month’s newsletter we reported on two end of year developments in the area of disability planning (also see the original Margolis, Bloom & D’Agonstino web post.) The first is the expansion of eligibility for ABLE accounts from only for people who became disabled before age 26 to anyone who became disabled before age 46. Unfortunately, this change will not go into effect until 2026. We don’t know why the wait or, for that matter, why there’s any age restriction at all.

In the other development, one of the last acts of Governor Charlie Baker’s administration was the issuance of a new regulation imposing a penalty on transfers to pooled disability trusts for individuals over age 65 in nursing homes and creating a new definition of a “pooled trust.”

The purpose of this article is to explain that the start date for implementation of the new regulation is uncertain, but it is not immediate.  The new regulations at 130 CMR 515.001, 130 CMR 520.008(I) and 130 CMR 520.019(D) state the changes are “[e]ffective sixty days after the end of the maintenance of effort and continuous eligibility provisions of Section 6008 of the Families First Coronavirus Response Act (Public Law No. 116-127).”  This is not a very clear implementation date.

Upon further review, based on the Public Law No. 116-127, the Consolidated Appropriations Act, 2023 and a recent CMS Bulletin, it appears the implementation date will be June 1, 2023, at the earliest, and March 1, 2024, at the latest.

It appears Governor Baker was determined to terminate the right of nursing facility residents to create and fund a pooled trust.  The Governor implemented the new regulations on his way out the door to make sure they went into effect as soon as the Commonwealth stops taking the increase in federal funding from the Families First Coronavirus Response Act. 

In the meantime, the Massachusetts National Academy of Elder Law Attorneys (“MA NAELA”) has filed legislation to change the regulation to maintain the right of our seniors to create and fund pooled trusts.  We are hopeful that the new administration will appreciate the benefit of protecting our elders’ rights to create and fund pooled trust so they have funds to pay for what MassHealth does not cover.  Please continue to read our e-letter because we will be reaching out to ask for your help to support MA NAELA in its efforts to protect the rights of the elders in the Commonwealth.

The Massachusetts Chapter of the National Academy of Elder Law Attorneys has provided this fact sheet. See Pooled Trust Fact Sheet

- See the full Margolis,Bloom & D’Agonstino article.

As reported previously, in early January 25 new behavioral health centers across the state and a 24/7 mental health hotline both launched to both increase access to mental health services and lessen the burden on emergency rooms.

To learn more about the centers, Greater Boston host Craig LeMoult spoke with Kathy Mague, senior vice president of the Behavioral Health Network with a center in Springfield, and Vicker DiGravio III, president of Riverside Community Care, with centers in Milford and Norwood.

“The idea is it’s a one-stop shop for whole health wellness care for individuals with substance use and mental health challenges,” Mague said. “What’s different is that there is no wait for care … we get to serve you immediately.”

Mague noted that in the past, similar centers had therapy as the “one tool in their tool box." Now patients will have access to recovery coaches and community health workers who will also provide support related to housing, food and transportation. The centers will also have enhanced medical capacity to address low-level medical needs to treat patients more holistically.

DiGravio said the new centers' services mean patients don’t have to face long waits when they come to emergency rooms for mental health crises.

While closing the mental health care gap in access will take a long time, DiGravio said these new centers are an important start.

“We have experienced 40 years of underfunding and neglect of the community behavioral health system,” he said. “This is really transformational, but it’s not going to fix 40 years of underfunding in four weeks or four months … but it’s a very important step.”

New Flowchart

The MA Executive Office of Health & Human Services has also rolled out a new social media graphic flowchart – helping educate the public about the new 24/7/365 Help Line, and the existence of 25 Community Behavioral Health Centers throughout the commonwealth.

- See the full WGBH story with additional information from Site Neutral Payments, Baystate on Workforce, and more, MHA's WEEKLY WRAP-UP mhacommunications@mhalink.org, February 24, 2023.   

Heaps of Hope reaches out to some of the most vulnerable in our society: women with a cancer diagnosis. It was inspired by one woman's journey through breast cancer with the desire to reach out to other women during this time. A serious illness puts a great deal of stress on every aspect of a person's life, including their financial situation. Heaps of Hope assists women through this time by:

• Offering assistance with the cost of transportation to medical appointments
• Helping pay for medications when women have no prescription coverage or have very high co-payments for their medication
• Helping pay hospital bills for uncovered treatments or tests
• Assisting with the cost of integrative therapies which are not covered by health insurance and can be helpful treating pain, nausea, insomnia and anxiety
• Offering grocery gift cards to help ease the financial strain that this illness can cause
• Providing an inspirational book - There's No Place Like Hope - to women who are newly diagnosed

More information: Heaps of Hope, Inc.

The program requires referral from a medical professional: Contact Heaps of Hope, Inc.

- Thanks to Lauren DeMarco for sharing this resource

President Biden’s decision to lift the COVID-19 public health emergency means a sweeping series of changes to the health care system — ranging from free mail-order COVID-19 tests to new rules for nursing home admissions — will come to an end May 11.

Many of the emergency provisions eased regulations and provided resources to speed up access to care, in ways that proved effective and popular, and in many cases were complemented by additional measures taken by state governments. Some, such as insurance coverage for telehealth, have already been extended, and industry groups are lobbying to preserve other measures. Some COVID-related services will remain in place under state or federal law.

As a result, Massachusetts providers and health officials are still sorting through the effects of ending the emergency, as state laws, state decisions about Medicaid, and other federal decisions come into play.

When it comes to Medicaid programs, which were allowed to eliminate copays and waive certain requirements, “there’s still wiggle room on what the state can decide to keep versus not to keep,” Figueroa said. Massachusetts has long had a generous Medicaid program, called MassHealth, he noted.

State officials said it’s too soon to know the impact of ending the public health emergency, because there are many variables and the federal government may retain certain aspects.

In Massachusetts, however, state law already mandates that health insurers cover all medically necessary COVID-19 services, without any copays or deductibles, spokespeople for health insurers said.

 “COVID-19 vaccines will continue to be free for those with insurance even when the public health emergency ends because of various federal laws, including the Affordable Care Act” said Amy McHugh, spokeswoman for Blue Cross Blue Shield of Massachusetts.

Paxlovid, an antiviral that alleviates COVID-19, must also be covered, she said.

The federal program allowing people to order eight rapid tests through the mail will end, however. But there may be ways to buy the tests at pharmacies and charge them to health insurers.

Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said insurers are required to cover both PCR and rapid antigen tests.

Still, Pellegrini added in a statement, ending the public health emergency “will have a considerable impact on health care costs, as pharmaceutical and vaccine manufacturers seek to significantly increase prices for COVID-19 vaccines, boosters, treatments, and tests as pricing protections tied to the PHE expire.”

Moderna and Pfizer have said they’re considering charging $110 to $130 per vaccine dose, far more than the federal government paid.

Here are some aspects of health care likely to be affected:

Nursing homes: The public health emergency waived a requirement that patients must have stayed at least three days in a hospital before Medicare will pay for their nursing home stay. That allowed patients to be admitted to a nursing home after only a short hospital stay, or even after a visit to the emergency room, said Mary Moscato, president of Hebrew SeniorLife Health Care Services.

Eliminating this waiver will lead to longer stays in already overcrowded hospitals, Moscato said. But she is hopeful the nursing home industry will persuade the federal government to make the waiver permanent.

Telehealth for mental health and addiction treatment: Remote visits with mental health providers will continue to be covered by Medicare at least until 2024. After that, patients will be required to see their provider in person at least once every 12 months, said Dr. Miriam Komaromy, medical director of Boston Medical Center’s Grayken Center for Addiction.

Several other telehealth flexibilities instituted during the pandemic will continue, with Medicare paying for video- or audio-based treatment at home and other locations.

And, a pandemic-era change that allowed telehealth prescriptions for buprenorphine, a medication for opioid use disorder, has already been extended through 2024. But a proposed rule change would make it permanent, “so the PHE ending should not (theoretically) have an impact,” Komaromy said in an e-mail.

MassHealth: During the pandemic, state Medicaid programs were barred from removing anyone from their rolls after March 18, 2020. MassHealth swelled to 2.3 million people, the largest number ever. But now, starting April 1, the program must resume checking all enrollees’ eligibility. This change is not caused by the expiration of the public health emergency but had already been required by Congress.

MassHealth will also face questions about whether to eliminate other pandemic-era changes, such as the elimination of cost-sharing and waiving prior-authorization requirements.

- See the full Boston Globe article.

A court has ruled in favor of a nationwide class action to restore Medicaid benefits to individuals dually eligible for Medicaid and Medicare whose benefits were reduced after March 18, 2020 to only the Medicare Savings program, despite a federal statute prohibiting loss of Medicaid benefits during the pandemic. This was a nationwide class action that will apply to Massachusetts. MassHealth implemented the unlawful federal regulation from July, 2021 through July, 2022 by reducing benefits for certain dually eligible elderly and disabled individuals  from MassHealth Standard to only Medicare Savings benefits (the Buy-In and Senior Buy-In programs).

This ruling orders the U.S. Department of Health and Human Services to stop enforcing an illegal Trump-era Interim Final Rule (IFR) that stripped vital Medicaid benefits away from hundreds of thousands of low-income individuals protected by law against loss of Medicaid coverage during the COVID public health emergency.

As a result of this decision, states must promptly reinstate benefits to all individuals who have lost them since March 18, 2020 or risk losing substantial federal Medicaid funding. These individuals will also remain on Medicaid during the “unwinding” when the pandemic-era funding program begins to end, a process that starts on April 1, 2023.

This unwinding process requires state Medicaid programs to fully evaluate whether individuals kept on Medicaid due to the pandemic might still be eligible before terminating their coverage. The injunction means that thousands who were already improperly cut off will also get the benefit of this careful review prior to termination, and advocates believe many of these people will then be found to be eligible for continued Medicaid coverage. The injunction will ensure continued access to vital benefits without interruptions in care or services.

- See the full National Health Law Program article.

From: Federal Court in nation-wide class action restores Medicaid benefits to dual eligibles, Vicky Pulos, MLRI, February 1, 2023.

It has long been a standard MassHealth planning tool of spouses of nursing home residents — so-called “community spouses” — to shelter “excess assets” by purchasing qualified annuities. MassHealth will pick up the cost of nursing home care for a married resident when the combined countable assets of the couple have been spent down to just over $150,000 ($148,620 for the community spouse in 2023 plus $2,000 for the community spouse). The community spouse may shelter assets above $150,000 by purchasing an immediate annuity for a term that is shorter than the community spouse’s life expectancy.

An immediate annuity is a contract with an insurance company for a stream of payments. For example, if the couple has $300,000 in countable assets and the community spouse’s actuarial life expectancy is six years, the community spouse may buy a five-year annuity paying back $30,000 a year, plus interest, and MassHealth will pick up the cost of the nursing home spouse’s care. The annuity must meet certain requirements for its purchase not to be considered an uncompensated transfer of assets causing a transfer penalty. (We describe this strategy more fully in a legal guide which you may download here.)

The issue that has been in dispute, and which is resolved in Laurie A. Dermody vs. Executive Office of Health and Human Services (SJC-13199, January 27, 2023), is what happens to the annuity payments if the community spouse dies before they have all been paid out. Are they payable to the Commonwealth to reimburse it for its expenses covering the care of the nursing home spouse or may they be paid to the beneficiaries named by the community spouse? The SJC decides this question in favor of the Commonwealth, reversing an earlier superior court decision.

While families of nursing home residents may disagree with this decision, at least it offers clarity. If a community spouse dies before receiving full payment on a qualifying annuity purchased for MassHealth planning purposes, the Commonwealth will be entitled to reimbursement for payments made on behalf of the nursing home spouse.

This means that annuities continue to be good strategies for protecting the financial security of community spouses, but they will be less likely to be able to pass on the sheltered asset to their children or other beneficiaries.

- See the full Margolis Bloom & D'Agostino post.

It can be hard for renters to find a place to live, especially people relying on government assistance. In the past year, the rental market has shrunk considerably. Gerry McCafferty, housing director for Springfield, said the city has been fielding many more calls from people whose rents have suddenly gone up — by as much as 40%. And they don’t have other places to go. “It's really hard to find vacant units at all,” she said. “But then when you find vacant units, they cost more.”

So when Amanda Freeman heard from her college that she was eligible for a rent subsidy known as a Section 8 voucher, she thought her problems were over.
But they really weren’t.

How Section 8 housing works

Section 8 vouchers, also called Housing Choice Vouchers, come from the federal government. Public housing authorities, often run by cities or regional agencies, each get a set number of vouchers to distribute.

With a voucher, a tenant can theoretically live anywhere that accepts it — including market-rate apartments, although the first year must be in the region in which someone applied.

The tenant pays about a third of their income towards the rent and the government pays the rest. It can be a great deal, but Section 8 waitlists are notoriously long.
Katelyn Reardon oversees Section 8 vouchers for the Franklin County Regional Housing and Redevelopment Authority. Like many regional and municipal offices, it uses the state’s centralized waiting list.

When Reardon looked up the latest numbers, she said, “There's a total of 464,493 applicants.” Although almost half a million people across the state are on the waiting list, Reardon said, “Each housing authority has their own preferences for how they organize all those people on the waiting list.”

For instance, the Franklin County authority prioritizes people who live in the region, as well as local veterans, which comes to almost 1,300 people. To get to the top, Reardon said, it takes around three years. That’s not bad given that in many places the wait can last more than a decade.

On its website, the federal housing department, HUD, acknowledges long Section 8 waitlists around the country due to “limited resources.”

In an email, a HUD spokesperson said that while 100,000 new vouchers were created in the last few years under the American Rescue Plan Act, that still leaves enough for only a quarter of those who qualify.

The spokesperson said President Biden’s proposed budget would include 400,000 more Section 8 vouchers over the next two years.

In some cases, individual housing authorities like Northampton pull from their own waiting lists that were frozen almost a decade ago because they were so long. To reopen a waiting list, officials say, a municipality generally has to enact a lottery system. That involves a closely regulated public information campaign, so it's not a decision local officials take lightly.

Some cities have more vouchers than others, based in part on population and poverty numbers from more than 20 years ago, according to HUD.

Holyoke, for example, reports having about 1,800 vouchers, but more than 6,000 people on its waitlist. Springfield has 3,000 vouchers, and pulls from the state’s centralized waiting list.

The western Massachusetts nonprofit Way Finders tells people to expect a 10-to-15-year wait for Section 8 housing.

“We have thousands of people on the waiting list for vouchers,” said Way Finders CEO Keith Fairey.

While Way Finders has almost 6,000 housing vouchers for Hampden and Hampshire counties combined, only a small portion become available every year. There’s usually only turnover when people are no longer eligible; for instance, their income went up or they needed to leave the area.

“The need is much higher than the availability,” Fairey said. “That's not unique or new to Hampshire County or Massachusetts, but that's a problem in our country around housing affordability.”

According to a state spokesperson, COVID relief funding did lead to about 900 new emergency vouchers, but for most people, the waiting list didn’t budge.
For some housing advocates, the mere fact there’s a waiting list at all seems ludicrous.

Chris Norris is with Metro Housing Boston, which co-wrote a recent report about rental assistance in Massachusetts. He said housing should be treated like an entitlement program.

“Folks get to collect Social Security if they meet the requirements. They get to collect unemployment if they meet the requirements,” Norris said. “Right now, the way housing works is: you may be eligible, but we're sorry, we're out of money. You have to wait in line.”

Problems Don’t End When You Get a Voucher

But even with a voucher, actually finding a place can be the next nightmare. First off, the unit has to be a government-approved size and meet more than a dozen conditions — like a large enough fridge, adequate air circulation and outdoor screens.

Then there’s the cost. If the rent is more than what the government has calculated as fair-market value, you can’t use a voucher. And these days, landlords often charge much more than what the government thinks is fair.

For example, in 2022, the “fair-market” rent for a one-bedroom apartment in Amherst was calculated at less than $900 a month, although most units were going for much more than that.

“I'm just looking for a place to put a bed and a table to study, and have a refrigerator and a stove,” Freeman said. Even so, many of the 100 or so places Freeman considered did not pass federal guidelines, or they cost too much, or she was competing with 30 other people.

Initially, Freeman was only given 60 days to use the voucher before it went back into the general pool. She got two extensions. When we first spoke, she only had a few weeks left and didn’t know how long she could stay with her friend. “I’m technically homeless,” she said.

- See the full WBUR article (and see what ultimately happened with Freeman’s housing search).

Nearly every day, scores of Haitian men and women, some of whom walked thousands of miles to seek asylum in the United States, make their way to a modest office in Mattapan Square, the headquarters of the nonprofit Immigrant Family and Service Institute.

The migrants, who have been granted Temporary Protected Status by the U.S. government, are looking for help getting jobs as they navigate an arduous process that is beset by maddening delays and absurd anomalies. Many of them spend long hours inside the IFSI office, waiting to get guidance from staffers who are themselves frustrated by the slow pace of the federal bureaucracy.

“It is frustrating,” said David Dorvilien, a 30-something man who sat in the bustling office on a recent Monday morning. A native of Haiti, Dorvilien says he has plenty of job opportunities here in Boston, but, like many of his fellow asylum seekers, his TPS status does not include permission to work. For that, he has to secure a special permit — called an Employment Authorization Document.

He has now been waiting for more than a year to get that permission.

Royal Caneus, 41, tells a similar story. He’s a “guy who gets things done” and is ready to do whatever job he can find once he gets his paperwork. But he worries that may never come.

“I did not think this would happen,” he said, noting he arrived from Brazil in 2019. “I’m seeking refuge here from something very dangerous and in May I’m here four years and can’t get the right paperwork for me to work.”

For many Haitian migrants who arrived from South America and Mexico, they now find themselves stuck in limbo instead of the land of opportunity.

The problem is national in scope. Officials with the U.S. Citizenship and Immigration Services blame the long wait on labor shortages, as well as a backlog of applications left to them by former President Donald Trump’s administration.

A spokesperson for USCIS told the Dorchester Reporter that “adjudicators evaluate each EAD application fairly, humanely and efficiently on a case-by-case basis, and the agency remains committed to upholding America’s promise as a nation of welcome and possibility with fairness, integrity and respect for all we serve.”

The spokesperson said new policies have been adopted under the Biden administration “to reduce both the number of pending cases and overall processing times the agency inherited from the prior administration.”

The agency’s “backlog reduction goals” include making changes to underlying procedures to achieve “new efficiencies while ensuring the integrity and security of the immigration system,” the spokesperson said.

Congresswoman Ayanna Pressley, who co-chairs the House’s Haiti Caucus, is one of a number of leaders who have grown impatient with the long delays.

“I am disappointed by the ongoing backlog of TPS applications that has hindered so many of our Haitian neighbors from living a dignified and stable life,” said Pressley. “Undoubtedly, U.S. policies regarding the Haitian people have perpetuated anti-Blackness and exacerbated injustice. It is past time to prioritize humanitarian relief. I won’t stop fighting for a just immigration and foreign policy.”

IFSI director Geralde Gabeau said most of the migrants could be helping relieve high-profile labor shortages in hospitals, nursing homes, construction sites, and school bus transportation. Instead, they find themselves sitting on the sidelines.

“When we were making plans with the city and the state to place families, our idea was we would place them and do the work permit, they would find a job, and very soon they would be on their own, so they don’t have to rely on us for a long period of time. All of those people here are very young, dynamic, and ready to work. There are jobs out there. The jobs are not lacking.”

Even more frustrating, the TPS and EAD allotments available for Haitian migrants run out on Feb. 3. That means anyone who finally gets authorization now will immediately have to renew their TPS and work permit. The problem is that until last week the federal government hadn’t spelled out how to renew.

- See the full WBUR story.

When children are poisoned by lead paint, the state has systems in place to help. But those resources are often out of reach for children in families of undocumented immigrants.

The parents fear that allowing a lead inspector into their home could lead to deportation. Their landlords have little incentive to remove the hazard. And funding programs for lead paint removal require documentation that they don’t have.

A spokesperson for the Massachusetts Department of Public Health called lead poisoning a “critical health equity issue” because the data shows it disproportionately affects lower income communities and communities of color.

“Recent immigrants, especially undocumented immigrants, and refugees without economic means tend to settle in the same low-income communities and therefore are more likely to be at risk of lead exposure,” the spokesperson said in a statement.

Dr. Amelia Monteiro, a pediatrician at the Greater New Bedford Community Health Center, said she sees lead poisoning frequently among her patients, who are mostly immigrants.

“I think it’s a population that is generally more at risk based on the type of housing that they tend to end up living in,” she said. That housing is generally older and poorly maintained, which means it’s more likely to have chipping lead paint.

Lead poisoning can cause lasting brain damage. Even small amounts of lead exposure are linked to slower development and problems with behavior and learning. Young children can come into contact with lead by putting their hands or mouth on surfaces with lead paint chips or dust.

“It kills neurons, and they do not come back,” said Dr. John D. Leimert, a pediatrician at Southcoast Health. “Significant lead exposures can lead to developmental disability for a lifetime.”

But when the parents of Dr. Leimert’s patients found out that lead paint was poisoning their child, their landlords usually didn’t want to do anything about it — and undocumented families struggled the most, he said.

Dr. Monteiro said her patients’ families have gotten pushback from their landlords, too. They’ve said things like, “You’re lucky to have housing,” and even threatened to turn them in to ICE.

“I’ve heard it many times where they’ve just been told, like, ‘OK, then you should probably just move out. Why don’t you go and find a new a new apartment?’” she said. “Which is no easy feat for any family as in this day and age with the housing market being the way that it is, but it’s an additional challenge for our immigrant families.”

Those landlords are breaking the law. In Massachusetts, property owners are required to remove or cover lead paint in any home with a child under 6, and it’s illegal discrimination if they refuse to rent to families with children.

But enforcement of the state lead law is entirely complaint-driven, according to New Bedford Health Department officials. And undocumented immigrants are often afraid to complain.

A spokesperson for the Department of Public Health said its Childhood Lead Poisoning Prevention Program doesn’t ask families for their immigration status, and it provides case management regardless of immigration status.

• Have your doctor screen your child and have your home inspected for lead.
• If your child is lead-poisoned, talk and work with the team assigned to help you. Your lead inspector and community health worker can give you advice that fits your family’s needs, identify exposure sources, and help bring your home into compliance.

More information about lead poisoning is available on the program’s website.

New Bedford is one city that has grants and 0% interest loans available to help low-income families and their landlords remove lead paint. But even if a landlord is interested in applying, the applications ask tenants for specific identifying information and documents like tax returns and photo ID.

“That’s not gonna happen — that is creating barriers,” said DaSilva Hughes of the Immigrants Assistance Center. Immigrants without legal status often don’t have those documents.

- See the full New Bedford Light article.

With a MA COVID-19 emergency order set to expire on March 31, state leaders are facing a choice about whether to permanently update our policies to provide seniors with the support they need.

Assisted living, which has been certified and regulated for nearly three decades in Massachusetts, combines residential and personalized support services designed to meet the needs—both scheduled and unscheduled—of those who require help with activities of daily living. Residents can receive help bathing, dressing, grooming, eating, and with other similar personal care needs.

While nurses serve residents in every assisted living community, state law historically prohibited them from providing any skilled care whatsoever to residents. In the cases where a resident needs care, they must have a family member administer it or arrange and pay separately for an outside provider.

During the COVID-19 pandemic, a state emergency order has allowed assisted living residences to deliver a handful of additional health services, including blood sugar monitoring for residents with diabetes, simple wound care for skin tears or other minor injuries, and assistance with oxygen. Unless state lawmakers act to make these common-sense health services permanent by the end of March, families could once again be forced to administer them personally or pay for private nurses.

We don’t believe that otherwise healthy older adults should have to pack up and move into expensive skilled nursing facilities due to their need for services as simple as a finger prick to check blood sugar. Some residents are going across the border to New Hampshire, Rhode Island, or Connecticut, where in-house treatments are permitted in assisted living.

Also distinct in Massachusetts, compared to more than 40 other states, is that the Commonwealth does not extend a Medicaid waiver to cover assisted living. Currently, our waiver only allows qualifying older adults to choose between home care services or skilled nursing facilities. It does not provide them with the popular option between those settings on the continuum of care – to live and receive care in assisted living.

How could we fix this? The state could extend the frail elder waiver to assisted living as a cost-effective approach to both save the Commonwealth dollars and provide independence and quality of life to older adults.

Additionally, Massachusetts could help seniors (and keep more affordable residences open) by enhancing rates for Massachusetts’ support programs, such as Program of All-inclusive Care for the Elderly, Senior Care Options, and Group Adult Foster Care.

By strengthening our financial support and services for residents in assisted living, we have an opportunity to improve the lives of older adults who just need a little help to remain active and independent in the communities they love.

- See the full CommonWealth Magazine opinion piece.

Adults with Developmental Disabilities Deserve Real Lives

The adult services system for individuals with intellectual and developmental disabilities in Massachusetts is badly broken. Currently, thousands of individuals are without services. They are stagnating at home, taxing the ability of their families to keep them safe, healthy, and engaged in anything meaningful. Time, resources, and the skills gained through years of special education are disappearing.

Everyone points to the nationwide workforce shortage to explain the ongoing crisis. But bad faith policy and administrative decisions made by the Massachusetts Department of Developmental Services are aggravating this untenable situation.

I am the mother of an autistic adult. When my son was transitioning to adult services, I explored the traditional day program options offered by DDS. None of the programs offered the growth and community participation that he and his peers deserve. So, along with a few other parents, I started a more personalized program that focuses on learning, skill building, social opportunities, and inclusion. It’s available through self-direction.

Self-direction is a 21st-century adult disability solution that began in the mid-1990s with pilot grants from the Robert Wood Johnson Foundation. The idea is that individuals and their families should be able to choose the services and supports they need and use their allotted government funding to buy them.

People can, for example, use self-direction to pay for supports that will enable them to access learning, recreational, or vocational opportunities in the community. Research shows that people living self-determined lives are happier, better employed and educated, and have a higher overall quality of life.

The successful pilot programs led the federal government to offer matching funds for self-direction. In 2002, stimulated by this new federal guidance, many states began promoting self-direction opportunities. In 2014, Massachusetts enacted the Real Lives law, guaranteeing the right to self-direct and ordering the Department of Developmental Services to make it happen.

The vision of the law’s sponsors and promoters was far-reaching: Families, people with disabilities, providers, and DDS would work together as partners, sharing resources for solutions that would respect choice and maximize opportunities. Budgets would be transparent, families would have help from independent facilitators, and anyone eligible for services could participate.

But none of that happened. Although the law was passed in 2014, DDS didn’t even propose regulations governing self-direction until a few months ago.

As many as 135 people attended an online public hearing hosted by DDS in November on the proposed regulations, and 58 people presented testimony. Comments ranged from polite requests for wording changes to passionate outpourings from parents at their wits’ end, confused by the system, frightened at their inability to care for their children, and certain the proposed regulations would make it worse.

A summation, of sorts, came from The Arc of Massachusetts, a venerable and judicious organization representing individuals, families, and agencies involved with developmental disabilities. The ARC wrote: “The Department of Developmental Services has proposed regulations which do not appear to properly implement or interpret the law which it has been directed to administer.”

The Real Lives law is at once both progressive and conservative. It is important human rights legislation. It recognizes the rights of individuals with disabilities to determine their own lives by making choices about how their budget can best be utilized to support their lives. It is conservative in that it promotes a market-based approach that supports the rights of individuals to make choices.

The workforce shortage crisis in Massachusetts that has marooned thousands of adults with disabilities has been intensified by DDS’s failure to implement the Real Lives law. It’s not that DDS didn’t realize it was missing the mark; three separate reports written by the respected Human Services Research Institute have critiqued the state’s progress since the law was passed.

The state agency responsible for implementing the law and its vision has fallen far short. I’m hopeful that Governor Maura Healey’s administration, with its strong commitment to equity, will quickly remedy that and bring Massachusetts’ adult disability services into the 21st century.

The future of my son, and thousands of other worthy individuals, depends on it.

Deborah Flaschen is a founder and volunteers as executive board chair of 3LPlace in Somerville, a learning center for adults with developmental disabilities.

- See the full Boston Globe opinion piece.

Real Families Need Real Lives Law Enforced

The reality a family faces when a loved one has an intellectual or developmental disability is that the road ahead will be filled with lifelong challenges.

Our son James is 32 and lives with us. His older sister and brother have both married and moved on. James has a unique sense of humor and terrific work ethic. He also has Down syndrome and limited communication skills.

Families with children who have intellectual disabilities embrace what we need to do to assist them to become the best versions of themselves. That means teaching and encouraging them to be good citizens and as independent as possible. We want for our children what everyone else wants: the best possible life. The path is just a bit steeper and full of assorted obstacles.

Unfortunately, state government is turning into one of those obstacles — especially for families that are just learning how to navigate the system.

We are veterans of that system. Our goal was to find a meaningful life for James, one that includes some work but also fun.

James has a good life filled with the activities and people he enjoys. He has a life of his choosing, called “self-direction.” But right now, it takes a lot of direction from our family for that to happen. What I hope for from Governor Maura Healey’s administration is more of a partnership between family and the state to make it easier. Self-direction is the terminology used to allow individuals with disabilities to utilize the most flexible funding that the Department of Developmental Services sets aside for people to design and choose the services and supports that work for them. DDS serves more than 32,000 adults but less than 2,000 people are self-directing. The Real Lives law passed in 2014 gives people the right to choose the services and supports, such as hiring their own support staff, taking classes, and choosing activities that interest them. Day programs are no longer the only option. But sadly, it hasn’t been implemented very well, if at all.

My friend’s daughter recently returned to a day program. Her daughter is 35 and because of COVID-19 was home with her parents with only occasional activity-based Zoom calls from a day program for the past three years. The mother retired to care for her. The family was never offered a choice, just told the day program couldn’t accept her back due to lack of staff. How is that sufficient or even reasonable?

According to the wording of the law, self-direction shall be available to any person, and their chosen planning team, who receives services from the department and agrees to implement a person-centered plan and purchase the necessary supports and goods; use the financial management service; and attend no more than once yearly orientation related to budgeting, planning, etc.

That’s what the law says. But that’s not what’s happening.

Why hasn’t the Department of Developmental Services created regulations, policies, guidance, orientation, or amend a home- and community-based waiver to meet the requirements outlined in the 2014 law? Transparency in the process and accountability to the law will allow more people with disabilities to have real lives. Individuals with disabilities and the people who care for and support them need to be provided the information, know-how, funding, and budget that reflect assessed needs and assistance to make this happen.

Logistically, it is also harder than ever to connect with DDS for help, because since the pandemic, DDS staff has been working remotely. The state has shifted to two to three days of remote work, but this work is based on relationships, knowing the people you’re serving, and assessing changing needs. DDS is a human service agency — human connection should be a reasonable expectation.

Susan Nadworny is chair of the MA Families Organizing for Change.

- See the full Boston Globe opinion piece.