Highlights

• Eviction Protection Ending
• SNAP Cliff
• Erroneous SNAP Expungement Letters
• Expunging Marijuana Records
• Tuition Free Community College
• Free Tax Prep
• Hospital Debt Advocacy
• Connector Special Enrollment Periods Extended
• Court Strikes Down ACA Preventive Care
• Medical Escort Difficulty

Sections

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

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

Since March 2020 the public health emergency Medicaid programs nationally (“MassHealth” in MA) were prohibited from removing people from Medicaid rolls except in very limited situations (they voluntarily withdrew, moved out of state, or died.) Congress ended this protection ends as of April 1, 2023. Medicaid programs now need to resume annual eligibility reviews, known as redeterminations.

April 1 marks the first time in three years that the state will begin combing through the insurance rolls to make sure that the only people receiving the coverage are those who are still eligible. That redetermination process needs to happen for some 2.3 million MassHealth recipients. Mike Levine, the assistant secretary for MassHealth, said in early March that an estimated 300,000 people will likely lose their coverage and be redirected to other health care.

MassHealth officials will have 12 months to work through every member. 

For those on MassHealth who still qualify and can be automatically renewed – about half of all recipients, officials estimate –  they will get a letter in the mail letting them know that no action is needed. If MassHealth needs updated information, the member will receive a blue envelope in the mail. The member then has 45 days to respond by mail, email, or phone call, which could kick off another three month window to send more information if needed.

The majority of people who will lose MassHealth will likely be earning slightly too much for the coverage now. Those members will probably still be eligible for subsidized insurance through the Health Connector, Levine said. 

In partnership with MassHealth and the Health Connector, the nonprofit consumer advocacy organization Health Care For All is engaged in a statewide effort to publicize the redetermination. Regional health groups are also working to eliminate coverage gaps.

“With such a massive undertaking, some will unfortunately fall through the cracks,” Amie Shei, president and CEO of the Health Foundation of Central Massachusetts, said recently. “Those most at risk of losing coverage even though they remain eligible include people of color, those with limited English proficiency, and individuals who are homeless or who experience unstable housing, as they may not receive redetermination notices in the mail or be able to respond promptly. This would undermine our efforts to improve health equity.”

Boston-based Health Law Advocates will be offering free legal assistance to people who may still qualify but incorrectly lose health coverage.

MassHealth is also staffing up in a big way to meet demand, planning to double customer service representatives in their call centers and scaling up their application counselor workforce, he said.

Sen. Cindy Friedman, of Arlington, said that it would probably be a challenge to staff the centers, which Levine acknowledged.

 “No one who runs a call center is having an easy time staffing that call center right now,” he said. MassHealth has contracted with two companies to provide additional capacity, he said, and they expect to reach their goal of doubling staffing levels “inside the next six to eight weeks.”

Outreach Materials

Consider displaying this poster in your waiting room or office.

More information and outreach materials.

- See the full article: State braces for MassHealth dislocation  - CommonWealth Magazine

More than 100 organizations have endorsed a call for lawmakers to extend a pandemic-era eviction prevention policy, warning that the looming March 31 expiration will displace Massachusetts residents and stymie other efforts to keep people in their homes.

A section of state law known as "Chapter 257" requires eviction cases to be paused when a tenant has an application pending for rental aid, such as through the Residential Assistance for Families in Transition (RAFT) program. That requirement ceases come April, bringing to an end what Massachusetts Coalition for the Homeless Associate Director Kelly Turley called "a critical upstream homelessness prevention tool and effective force for housing stability."

Housing advocates argue the process of applying for RAFT can take weeks or months to complete, a duration of time that does not mesh well with eviction cases in courts.

"Since going into effect in January 2021, at least 9,000 case continuances have been granted under the law, and untold numbers of tenants have been able to stabilize their housing and prevent eviction simply by having the chance to complete the rental assistance process," advocates wrote in the letter.

State Reps. Samantha Montaño and Peter Capano and state Sen. Liz Miranda filed legislation that would make the pandemic-era protections permanent (H 1682 / S 1048).

- See the full WBUR story.

During the Pandemic all SNAP households received the maximum SNAP benefit for their household size, regardless of their income. Those with low income who were already receiving the maximum benefit for their household size received at least a $95/month payment. These “Emergency Allotments” were disbursed as a separate payment each month. Congress ended these payments and the last ones went out in Massachusetts on March 2nd.

The emergency allotment — which provided another $90 million a year in food stamp funds to the state — added an extra $151 to the average household’s normal monthly benefit of $335, according to the state Department of Transitional Assistance (DTA).

Under a supplemental FY23 budget proposal from Gov Healey that was signed this week, DTA will cushion the blow by issuing 3 months of state-funded SNAP. SNAP households should expect April, May and June payments at 40% of the amount the household received in Emergency Allotments. Additional detail to follow.

The supplemental budget also includes funding for continuing universal school meals for the rest of the year and funds to replace “skimmed” SNAP benefits (benefits lost to scammers.)

“The end of the temporary emergency allotments will be a significant change that will increase food hardship for many individuals and families, given the modest amount of basic SNAP benefits and high recent inflation in food prices,” according to the Center on Budget and Policy Priorities, a left-leaning Washington, D.C.-based research group.

Advocacy Opportunity

Advocates can advise households that receive less than the maximum benefit for their family size to consider if they may be eligible for any income deductions that would increase their benefits. (Families already receiving the maximum benefit for their family size would not see any further increase in benefits.)

Maximum SNAP Benefits

Expenses that may be may be deducted from income:

• Dependent care costs (child or adult care)
• For people 60+ or disabled: unreimbursed healthcare costs
• Increased rend or homeownership costs
• Legally obligated child support

It is also important to tell DTA if you lost a job, had hours reduced or other reasons that your income has gone down.

More information

• Get the Most Out of Your SNAP – DTA
• SNAP and Medical Expense Deductions – Mass Legal Services
• SNAP and Dependent Child Care Deductions  – Mass Legal Services

Mass Law Reform Institute (MLRI) has recently learned that some SNAP households have received DTA notices that say their SNAP will be expunged (removed from their EBT account) if they don’t use those benefits. Most of these DTA notices were sent by mistake. The ONLY time SNAP benefits are expunged is when the household has not used any SNAP benefits for at least 274 consecutive days.  

DTA confirmed at Tuesday’s Coalition call that many of these notices are in error and these households will NOT have their SNAP expunged. DTA is working to fix these erroneous notices. Please reassure households the following: If they have used any of their SNAP at all in the past 274 days (9 months), their SNAP benefits will not be expunged.

- From Guv Healey signs FY23 Supp Budget with funds for SNAP & school meals; Repubs in Congress seek major SNAP cuts; Upcoming Immigrant/Benefits Training 4/5, Pat Baker, MLRI, March 30, 2023. 

Boston has expanded its tuition-free community college program to include all city residents regardless of age, income or immigration status.

Starting this fall, any city resident will be eligible to pursue an associate’s degree or certificate at one of six partnering local institutions without paying to attend. The program also includes a $250 stipend for incidental expenses each semester for up to three years, and up to $2,500 of debt relief for students whose account balances are keeping them from re-enrolling.

The partner community colleges include Benjamin Franklin Cummings Institute of Technology, Bunker Hill Community College, Massasoit Community College, MassBay Community College, Roxbury Community College and Urban College of Boston.

Important note: this does NOT mean that attending will be free. Tuition may be covered, but “fees” often are a larger portion of total costs. Here’s a sample of costs from Bunker Hill Community College.

Bunker Hill Community College, Tuition & Fees - Summer 2023

Massachusetts In-State Students

Source and see the full chart at: https://www.bhcc.edu/tuition/

In Boston and statewide, community college enrollment has suffered in recent years, with many high school graduates opting instead to enter a hot labor market. The program expansion is designed to nudge residents back on track to earning a degree,  Boston Mayor Michelle Wu said.

Boston officials also unveiled a new program in which MassArt will offer a tuition-free BACHELOR’s degree to students eligible for federal Pell grants who transfer from a partner community college.

Boston's tuition-free community college program has served over 1,000 students since 2016, according to city officials. In remarks Thursday, Wu said “students in the tuition-free community college program are three times more likely to graduate from community college than peers."

“These young people earn more credits, enjoy higher employment rates and report higher earnings,” she said.

The program comes alongside an expansion of free community college at the state level, including the MassReconnect program, which is aimed at residents without a degree who are over the age of 25.

- See the full WBUR story.

With access to a widely-used abortion medication on the line, Massachusetts is trying to walk and chew gum at the same time – warning local pharmacies that they must continue supplying the medications, while gearing up for a potentially disruptive ruling out of Texas that could throw abortion care systems into chaos.

“Clarifying guidance” from the Massachusetts Board of Registration in Pharmacy states “all pharmacies located in Massachusetts and licensed by the Board must maintain a continuous, sufficient supply of all family planning medications.” The advisory reminds pharmacies that they must dispense the medications to patients with valid prescriptions or face state investigation.

“Here in Massachusetts, we will always protect access to reproductive care, including abortion,” Gov. Maura Healey said in a statement. “At a time when states are rushing to ban medication abortion and some pharmacies are irresponsibly restricting access to it, we are reminding Massachusetts pharmacies that they have an obligation to provide critical reproductive health medications, including Mifepristone. It’s safe, effective, and legal.”

Most abortions in the US are performed through medication rather than surgery. A two-drug combination of Mifepristone and Misoprostol has been approved by the US Food and Drug Administration since 2000 and cleared for terminating pregnancies within the first 10 weeks. 

The Healey administration move seeks to head off companies that may decide to limit access to medication in the state because of the fraught national environment. Walgreens, a major pharmacy chain in the state, this month announced plans to stop offering abortion pills in 20 states where Republican attorneys general threatened legal action against the company if it continued to provide the medication. 

Medication like Mifepristone remains legal in Massachusetts, but reproductive health groups are still waiting anxiously for a ruling out of a Texas federal district court that could sow nationwide confusion about the drug’s legality. 

Judge Matthew Kacsmaryk, hearing a challenge questioning Mifepristone’s initial approval 20 years ago, appears to be open to a claim that the medication is unsafe. 

Legal experts say the judge does not clearly have the authority to unilaterally ban Mifepristone nationwide, as the FDA has statutory procedures to review and remove a drug from the market. Should Kacsmaryk order the FDA to pull Mifepristone or impose tighter restrictions, the agency may decide to begin the congressionally mandated public review process or decide not to enforce the ruling. 

Regardless of the outcome, parties are expected to appeal. This would send the case up through the Fifth Circuit and may land it before the US Supreme Court. 

In the meantime, “part of the point of this lawsuit is to cause confusion and chaos among patients who are seeking abortion care,” said Rebecca Hart Holder, head of Boston-based Reproductive Equity Now. It is possible to use a less-effective one-drug regimen if Mifepristone is banned, and more patients may consider surgery to end early-stage pregnancies, Hart Holder said. 

The waiting period while Kacsmaryk considers the case is “very frustrating,” Hart Holder said, but advocates are focused on containing panic, which she says government action like the Healey advisory can help with. “All abortion care is legal in Massachusetts,” she said. “Patients will still be able to access care after the ruling because we will need to see how the FDA reacts.”

- From Healey warns pharmacies to keep abortion meds stocked, CommonWealth, March 23, 2023.

Last year, Massachusetts passed a law making it easier for residents to expunge marijuana crimes that have since been decriminalized from their records. But the process still isn't automatic. Individuals have to initiate their own requests, and not all are eligible.

The state also has a webpage to help residents find out if they're eligible and request an expungement.

For More information see the booklet- How to Expunge Decriminalized Marijuana Offenses

The Biden administration has announced that thousands of Ukrainians who fled to the United States in the first months after Russia invaded their country would be eligible to extend their stay, as the war in Ukraine continues into a second year.

About 25,000 Ukrainians and their family members who came into the country through Mexico at a U.S. port of entry between Feb. 24 and April 25 last year were allowed to stay for a year. The Department of Homeland Security said it would consider one-year extensions for that group.

The total two-year period aligns with the length of time Ukrainians fleeing the war were later permitted to stay in the United States under a program in a system known as humanitarian parole.

Nearly 300,000 Ukrainians and their families have entered the country since the start of the war under humanitarian parole, with a visa or as a refugee. More than eight million have fled to European countries in the past year.

The Biden administration had indicated that it would find a way to let the early Ukrainian arrivals extend their stay and work in the United States, but it did not announce a solution until this month. Thousands of Ukrainians had been left to wonder whether they would have to uproot themselves to find refuge in another country while the war raged on in theirs.

“This process will provide critical relief to thousands of Ukrainians who have been facing tremendous anxiety and uncertainty about their future here,” said Krish O’Mara Vignarajah, the president of Lutheran Immigration and Refugee Service.

Human rights advocates said people from other countries who are in the United States under temporary humanitarian parole should be given similar assurances. Ms. Vignarajah said protections would expire this summer for thousands of Afghans who were among the first to arrive in the United States after the rushed evacuation of Afghanistan in August 2021.

“The administration’s broader use of parole must be accompanied by a thoughtful plan for how and when temporary protections will be extended, and how beneficiaries can access pathways to longer-term status,” she said.

A legislative proposal to give Afghan parolees an opportunity to apply for permanent residency in the United States has failed to get enough Republican support.

- See the full New York Times article.

Families living at a temporary shelter in Devens were notified it is to close this month.
In a letter sent to residents and shared with WBUR, state officials said any families that haven’t been moved to a more permanent shelter would be relocated to a hotel in Concord.

The Devens facility, which opened last December, was intended to house families for just a few days as they entered the state-run family shelter system. It opened as the system experienced an influx of new migrants and other families in need of housing.

The facility drew an immediate backlash from many advocates for the homeless, who said the “barracks-style” set-up was unsuitable parents with children, and they worried about the possible spread of infectious diseases. Advocates said it marked the first time the state’s Emergency Assistance program had not provided qualifying families with private space.

When the state announced the closure, there were 100 people — including 46 adults and 54 children — being sheltered at the intake center.

- See the full WBUR article.

There are free, virtual and local opportunities for consumers who need help filing their taxes. Consumers are advised to call ahead to schedule an appointment. Some of the available resources include:

The Volunteer Income Tax Assistance (VITA) program offers free tax help to people who generally make $60,000 or less, persons with disabilities and limited English-speaking taxpayers who need assistance in preparing their own tax returns. IRS-certified volunteers provide free basic income tax return preparation with electronic filing to qualified individuals.

The Tax Counseling for the Elderly (TCE) program offers free tax help for all taxpayers, particularly those who are 60 years of age and older, specializing in questions about pensions and retirement-related issues unique to seniors. The IRS-certified volunteers who provide tax counseling are often retired individuals associated with non-profit organizations that receive grants from the IRS. 

Find a VITA or TCE site

AARP Foundation Tax-Aide offers free tax help to anyone especially for those age 50 and older who can’t afford a tax preparation service. IRS-certified volunteers understand that retirement or other life changes may make tax filing a little more complicated. AARP membership is not required. https://www.aarp.org/money/taxes/aarp_taxaide/

Boston Tax Help Coalition offers free tax preparation and filing in 15 neighborhoods at 30+ different locations. Some sites also offer financial guide check-ups. Boston Tax Help Coalition – It's like money in your pocket!

- From: Reminder: Free Help with Tax Preparation, Massachusetts Health Care Training Forum, March 16, 2023.

Did you know that under federal law, nonprofit hospitals must offer free or discounted medical care to low- and middle-income patients, even families making as much as $70,000-$90,000 a year?

Many patients don’t realize they may qualify for hospital financial assistance programs, also known as charity care. These programs can reduce or even eliminate medical bills. 

Dollar For is a national nonprofit that crushes medical bills by empowering patients and advocating on their behalf.

The Affordable Care Act requires nonprofit hospitals to offer charity care programs to keep their tax-exempt status. These financial assistance programs reduce or eliminate medical bills for low-to-middle income patients. 

Dollar For is here to help. We educate patients about these programs, help patients navigate the application process, and call out hospitals that don’t follow regulations. We have already crushed over $19 million in medical bills. Our work is entirely funded through philanthropic grants and donations. Our services are completely free – no strings attached.

Our online eligibility screener—powered by our custom-built database of over 8,200 hospitals—helps patients quickly see if they are likely to qualify for financial assistance.

For eligible people, Dollar For offers self advocacy and full service options to help submit financial assistance applications:

• Our online manual and automated self-service system walk patients through the step-by-step process of applying for financial assistance.
• Our dedicated staff of patient advocates prepare and submit applications, then help patients follow up on cases. Dollar for has already helped patients submit over 3,200 charity care applications.

More Information: https://dollarfor.org/

- Thanks to Lauren DeMarco for sharing this resource.

If someone loses access to MassHealth coverage, it is considered a loss of coverage and a Qualifying Life Event that triggers a Special Enrollment Period (SEP) for Health Connector Coverage.

A SEP means that someone can enroll in or change health insurance plans outside the annual Open Enrollment period. Beginning on 4/1, anyone who receives a SEP for any qualifying life event will have their enrollment window extended to 11/23. Other life events that let someone qualify may include:

• Changes in household make-up, income, immigration status, or address
• Certain other life changes, like getting married, having a baby, or losing job-based health insurance

Applicants Must:  

Report any life changes that would impact their eligibility, like starting or ending a job, within 30 days of it occurring. Many life changes result in someone qualifying for a SEP. Payment and enrollment deadlines still apply during a Special Enrollment Period.

How Will this Work in the Online Application?

The online application will automatically open some SEPs, if reported eligibility changes result in a qualifying life event (for example, if the member is redetermined out of MassHealth and newly qualifies for Health Connector coverage).

If a qualifying life event was not reported in the online application, individuals can use the “Can I Shop?” button to complete a questionnaire to determine if they have experienced a qualifying life event.

When an applicant is in their online application, the SEP questionnaire screens will work as it currently does, but with an extended enrollment window.

Assisters and anyone helping an applicant should note that this will not display immediately, but the extension date will appear in the person’s application the following day.

The Health Connector will continue to mail members SEP decision notices, and we will request proof as needed.

- From NEW Health Connector Special Enrollment Period, Massachusetts Health Care Training Forum, March 31, 2023.

Major changes may be on the horizon for the Massachusetts family shelter system. The parties in a class-action lawsuit brought on behalf of homeless families have agreed to a settlement with the state. A judge is considering whether to approve the deal.

The agreement could revamp a state-run system that has struggled to keep up with a growing number of homeless families.

Some families have described waiting on hold on the state’s emergency shelter hotline for hours, day after day, to file an application for shelter. Other homeless families told WBUR they have returned to abusive situations or turned to emergency rooms for a place to stay as they apply to the state system.

The settlement aims to simplify and streamline the shelter application process. It also creates a more robust system for moving families closer to communities where they have ties through work, school and family, and providing accommodations for people with disabilities.

Kelly Turley, associate director of the Massachusetts Coalition for the Homeless, said the proposed settlement is a “game changer.” “It won't expand access to shelter to unaccompanied youth or adults without children in their households, but for families with children in need of shelter, I think it will make a fundamental difference,” said Turley, whose organization is not part of the lawsuit.

The state-run family shelter system

Massachusetts has one of the only state-run family shelter systems in the country. It currently houses nearly 4,000 families, up more than 30% from the same time last year. Advocates say the increase is due to factors that include high housing costs and more new immigrants coming to the state. This year, legislators committed more than $200 million to fund the system.

The class-action lawsuit, filed in 2016, alleged that delays getting shelter violated a unique state law that guarantees many families a right to shelter. The lawsuit also alleged that the system was not doing enough to accommodate families of people with disabilities, and was not doing enough to transfer families closer to their communities.

For the past few years, lawyers for homeless families and for the state have been working on a settlement, meeting at least weekly to hash out details. “Some of the things we proposed ... we were like, ‘Well, this is going to be a nonstarter,’ " said Laura Massie, senior attorney at Greater Boston Legal Services and one of the lawyers representing families in the lawsuit. "And then we were amazed that they were willing to say, ‘Yeah, let's talk about that. Let's find a way to address that.’"

What the settlement would change

The proposed settlement is more than 100 pages long and includes detailed instructions about what must change to make the system work better for families. The changes fall into three broad categories.

The shelter system’s front door

The settlement seeks to make the system easier to access. This includes provisions for simpler forms, a web portal to submit documents, and a voicemail system so families don’t have to wait on hold and instead receive a call back. Another provision requires families who are denied shelter to be given a written explanation, so the decision can be appealed.

In addition, many families would be given a place to stay while they complete the shelter application.

“There's a guarantee if you make it to the office by such-and-such a time — or call the phone line by such-and-such time — and [the Department of Housing and Community Development] has not determined you to be ineligible, then they'll give you a safe place to stay, at least for that night,” explained Massie. “We were very, very excited about that guarantee.”

Massie’s team also noticed that it’s often hard for families to immediately produce all the documentation they need to get into shelter, such as evidence of limited income and their reason for homelessness. This is one of the roadblocks that can leave families unsheltered. Under the proposed settlement, families would get shelter and have more time — often 30 days — to provide many of the necessary documents.

Keeping families closer to home

Sometimes families are given shelter far from their communities. This can mean they have to commute long distances to work and school, or to see friends and relatives. To address this, the settlement would create a more transparent and robust system to transfer families to shelters closer to the areas where they work and attend school. And, for the first time, families will be routinely asked where they consider home.

Accommodations for people with disabilities

The proposed settlement creates a system for prioritizing the most urgent needs for people with disabilities, and it allows the state to request a new shelter unit to fit a family’s specific needs.

For example, if a premature baby is being discharged into the shelter system and needs to remain near Boston Children’s Hospital, advocates say it would now be easier to make that possible. The state would also be required to keep data on which transfers and accommodations are and aren’t being met to show where new shelter capacity is needed.

People familiar with the shelter system say that, currently, many decisions are made on a case-by-case basis, and having an advocate from a local nonprofit can make a difference. Now, Massie said, the hope is to set up systems that function more smoothly and more equitably for all families in the system.

What comes next

Before ruling on the settlement, the judge on Tuesday requested a report about outreach related to the settlement. The report is due next week. Lawyers involved in the case said they expect the decision to come soon since the judge is facing mandatory retirement within months.

If it is finalized, implementation of the settlement terms is expected to take more than a year. The settlement will then be binding for three years. But the plaintiffs hope that once the new systems are in place, many of the changes will continue long into the future.

- See the full WBUR story

A federal judge in Texas ruled Thursday that employers can't be required to cover specified preventive health care services under the Affordable Care Act.

Why it matters: The ruling has major implications for the more than 150 million Americans on employer-sponsored health plans and could put millions on the hook financially for certain skin and lung cancer screenings, statins for heart disease, medications that prevent HIV and other services recommended by the U.S. Preventive Services Task Force.

The Biden administration is expected to appeal the decision and ask for a stay.

Context: The ruling stemmed from a case brought by six individuals and two Christian-owned businesses who argued that they should not be mandated to offer coverage of HIV PrEP because they did not want to encourage "homosexual behavior."

• Under the ACA, most health insurance plans must cover certain recommended preventive services, including HIV testing for people aged 15-65 and HIV PrEP for adults who are at high risk of getting HIV. There's no cost-sharing, a stipulation intended to get more enrollees to use them.
• Last September, U.S. District Judge Reed O'Connor ruled that ACA's PrEP mandate violated the defendants' rights under the Religious Freedom Restoration Act, a law that "ensures that interests in religious freedom are protected."
• The ruling today covers services the Preventive Services Task Force most highly recommends for preventive care. About 6 in 10 people with private health insurance, or roughly 100 million, use ACA-covered preventive health services, per the Kaiser Family Foundation.
• O'Connor is the same Texas judge who sided with the plaintiffs in an earlier major ACA court case, ruling that the law is unconstitutional and should be struck down.

The ruling has possible implications for the ACA's contraception mandate, which was challenged in the case. O'Connor rejected that challenge in a prior decision, but the plaintiffs are expected to appeal that as this case continues to wind through the courts, University of Michigan law professor Nicholas Bagley wrote on Twitter.
“All preventive services are kind of up for grabs as we go through the appeals process,” said Laurie Sobel, associate director for women's health policy at KFF.
What we're watching: With the ACA's preventive services requirement being voluntary, insurers can either drop coverage of these services or start charging enrollees for them.

• While some religiously motivated employers might attempt to move quickly, "for most people with insurance contracts being in place for a calendar year, I would think there would not be an immediate impact,” said Zachary Baron, associate director at Georgetown’s O’Neill Institute for National & Global Health Law.
• States regulate private insurance and may be able to preserve access to some preventive services, but are blocked by the federal ERISA law from regulating self-insured employer plans.
• The case could ultimately wind up at the Supreme Court, following the same trajectory as the last ACA lawsuit that O'Connor ruled on.

The ruling immediately removes a legal requirement of no-cost coverage for certain skin and lung cancer screenings, statins for heart disease, medications that prevent HIV and other services recommended by the U.S. Preventive Services Task Force, Axios' Adriel Bettelheim writes.

• The Biden administration is expected to appeal the decision and ask for a stay. If granted, that would put the ruling on hold as appeals work their way through the courts.
• "There will be no immediate disruption in care or coverage," AHIP, which one of the nation's largest health insurance trade groups, said in a statement Thursday.

Between the lines: Even in the short term, most large employers won't be racing to make changes by the next coverage year as they wait to see how this plays out in the courts.

• That's in part because insurance companies have to submit rate filings and submit to regulatory reviews, Garrett Hohimer, vice president for policy and advocacy for the Business Group on Health, told Axios.
• "It takes time to make design changes to your plan and communicate those," he said. With the likelihood of a stay and the typical timeline of the courts, it's unlikely to see any changes within the next 12 to 18 months for most employers, Hohimer said.

But even longer-term, Hohimer said he also doesn't expect a "wholesale abandonment" of preventative services, no matter what happens with this case, because insurers and large employers have seen their financial upside.

• "Preventative services have clearly helped avoid the need for more involved, more expensive coverage down the line and improve health and well-being currently and in the future," he said.

Yes, but: Insurers and employers could start shifting the cost of some services. That's no small matter in the case of a CT scan for lung cancer. And it's possible that coverage may return to the pre-ACA patchwork as carriers adjust.

• While many employers will still want to buy plans that pay for preventative services up front, "there are lots of employers who struggle to pay for health insurance as it is, so if this means savings for them, they're probably going to want to take that savings," said Michael Botta, a health economist and co-founder of Sesame, a direct-to-patient care company.
• Zachary Baron, associate director at Georgetown's O'Neill Institute for National & Global Health Law, agreed. "In some sense, when you do open up a Wild West that allows insurers and employers to pick and choose, I don't think there is going to be a uniform approach. That's just the nature of the market," Baron said.
• "There's such a wide range of services implicated here from tobacco cessation to different cancer screenings and things like that. And [employers] may have different data about what is used and how much and if they can tweak some of the cost-sharing around the margins to better meet their needs," Baron said. "It's opening Pandora's box where the Affordable Care Act had tried to create a baseline level of protections for consumers."

Be smart: Different parts of the health care system have built their business around getting people in the door with free preventative care — and could have to drastically change their strategy, Botta said.

• "If you ever get text messages from CVS that say 'Hey, come in for this free screening' ... or your doctor's office says, 'Come in for this free service,' that's a huge benefit for a lot of these practices because they're still getting paid for these services by your insurer but you as a patient don't have to pay for them," Botta said.

The bottom line: While change won't come overnight, workers can expect to be on the hook for some of the cost of services that had been free.

• And when it comes to evidence-based prevention, the decision would have the effect of returning insurers and employers back to coverage guidelines from before the ACA was law, 13 years ago.

- See the full Axios coverage: Judge strikes down Affordable Care Act preventive services requirement (axios.com) and Don't expect big changes to insurance, yet (axios.com)

Following even basic screenings and operations, patients often must arrange for someone to deliver them home. For older people, it can be a tall order. Older people across the country describe maddening efforts to find “door-through-door” escorts for outpatient surgery and screenings that involve anesthesia — especially if facilities require those escorts to remain on the premises until the patient’s discharge.

The problem is “rampant,” said Janet Seckel-Cerrotti, executive director of FriendshipWorks, a nonprofit whose trained volunteers serve as free medical escorts in and around Boston. “We see it every day. It’s hard on your dignity.”

Doctors explain that door-through-door requirements are a safety measure. With a colonoscopy, for instance, patients often receive an anesthetic, like propofol, or a narcotic such as Demerol or fentanyl, combined with anti-anxiety medication like Versed or Valium.

“They affect the brain, and they can stay in the system for four to six hours,” said Carol Burke, a gastroenterologist at the Cleveland Clinic and a past president of the American College of Gastroenterology. “You’re not in full control of your faculties.”

On a bus or in an Uber, she said, “what if you fall asleep or you start to vomit or you don’t remember where you’re going?”

Is such caution truly necessary? “A very hard question,” said Thomas Oetting, an ophthalmologist at the University of Iowa School of Medicine and a spokesman for the American Academy of Ophthalmology.

Though liability fears clearly play a role, “how safe do we have to be?” he asked. He specializes in cataract surgery, which also often involves intravenous anesthesia. After the operation, “if there’s a one-in-a-million chance that someone falls and breaks a hip, should everybody have to have someone take them home?”

For now, though, they usually do, forcing older patients without nearby family, or friends who still drive, to scramble.

Trying to solve the escort problem can require considerable research, involving providers, local nonprofits and home-care companies. Some possibilities:

Talk to your medical provider. Policies vary. The surgeons to whom Mr. Lewinger was referred require escorts for Mohs procedures, but most don’t, said Terrence A. Cronin Jr., president of the American Academy of Dermatology. “The local anesthesia we use is usually lidocaine, which doesn’t disrupt the mental abilities of our patients, so they are able to drive themselves home,” he said in an email.

Though liability fears clearly play a role, “how safe do we have to be?” he asked. He specializes in cataract surgery, which also often involves intravenous anesthesia. After the operation, “if there’s a one-in-a-million chance that someone falls and breaks a hip, should everybody have to have someone take them home?”

For now, though, they usually do, forcing older patients without nearby family, or friends who still drive, to scramble.

You can also consult your local Area Agency on Aging or use the Eldercare Locator to find public or nonprofit transportation services.

Contact home-care companies. Medicare doesn’t cover medical escorts. But if you can afford out-of-pocket costs, you may find help through a private home-care company. Unfortunately many home-care companies, already scrambling to hire staff, won’t agree to such short one-time stints, which produce less income than continuing assignments for both the aides and the agency. But some companies will, sometimes charging slightly higher rates than for continuing care. Give plenty of notice before your appointment.

- See the full New York Times article.

Massachusetts is doling out tens of millions of dollars in tax credits to developers of “unaffordable” housing in the state’s most impoverished communities, according to a new report.

The report by the Massachusetts Law Reform Institute said an analysis of the state’s Housing Development Incentive Program found that tax credits offered to date — totaling nearly $90 million — as well as local tax breaks, have been mostly for market-rate, above-market and even expensive luxury housing.

While the state is facing a shortage of affordable housing, particularly in so-called Gateway cities like Lawrence, Haverhill and Salem, the report said only 80 of the 4,085 housing units approved for tax credits through the program are considered affordable under the state’s own guidelines.

“Massachusetts is in the middle of a massive housing crisis, with some of the most unaffordable rental markets in the nation,” said Judith Liben, the group’s senior attorney and author of the study. “As currently structured, HDIP supports only higher-priced housing and does not address that need.”

In the report, Liben said the tax credits are not being distributed “evenly or equitably” among Gateway cities “and often go to strong or ‘hot’ markets where no taxpayer subsidy is needed, while neglecting cities that are market challenged.”

More than half of the tax credits have gone to only 5 of the state’s 26 Gateway cites, she noted.

Meanwhile, the report also claims there is “no monitoring, evaluation or reporting” on the results of the state’s investments to date — which include $89.4 million in credits approved or reserved for 61 developments, 31 completed and 30 under construction or pending.

“Unlike affordable housing tax credit programs that require developers to meet rigorous criteria to achieve a range of goals for the public good, HDIP imposes only minimal obligations in return for the millions in tax credits,” the report stated.

Gov. Maura Healey has proposed expanding the program as part of her $55.5 billion preliminary budget for the next fiscal year, filed earlier this month.

If approved, Healey’s proposal would authorize $192 million in tax credits over the next 5 years while raising the annual credit cap from $10 million to $30 million, indefinitely.

“This massive expansion would mean that in the next five years developers will receive at least $200 million in tax credits for expensive housing meant for smaller households with disposable incomes,” Liben wrote in the report.

To be sure, the HDIP program is the state’s only tax incentive for market-rate housing. It was created in 2010 to encourage more housing in Gateway cities that struggled to attract developers to revitalize their communities amid the fallout of the economic recession.

The market rate tax credits are also dwarfed by the amount of money the state spends annually on affordable housing, which totals hundreds of millions of dollars in tax credits and other incentives.

But the report notes that it doesn’t provide a “reasonable share” of affordable units and doesn’t “equitably distribute these tax credits to cities most in need.”

Lawmakers have filed a proposal that would require the state to offer more affordable housing credits through the HDIP program, specifically for mixed-income units. The bill, filed by state Sen. Jamie Eldridge, D-Acton, is being considered by the Legislature’s Joint Committee on Housing.

- See the full State House News Service article in the Eagle Tribune.