Highlights

• DACA Health Insurance
• Free Vaccines
• COVID Test Coverage Ending
• Workers' Comp Woes
• Foreclosure Prevention Program
• Health Care Navigation
• MassHealth Pandemic Wind Down
• Masshealth Redeterminations Resuming
• 3 Midnight Rule to Resume
• Caution on Competitive Energy Suppliers

Sections

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

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

The Supreme Court has temporarily preserved women’s access to a drug used in the most common method of abortion, rejecting lower-court restrictions while a lawsuit continues.

The justices granted emergency requests from the Biden administration and New York-based Danco Laboratories, maker of the drug mifepristone. They are appealing a lower court ruling that would roll back Food and Drug Administration approval of mifepristone.

The drug has been approved for use in the U.S. since 2000 and more than 5 million people have used it. Mifepristone is used in combination with a second drug, misoprostol, in more than half of all abortions in the U.S.

The court’s action almost certainly will leave access to mifepristone unchanged at least into next year, as appeals play out, including a potential appeal to the high court. The next stop for the case is at the New Orleans-based U.S. Court of Appeals for the 5th Circuit, which has set arguments in the case for May 17.

Women seeking to end their pregnancies in the first 10 weeks without more invasive surgical abortion can take mifepristone, along with misoprostol. The FDA has eased the terms of mifepristone’s use over the years, including allowing it to be sent through the mail in states that allow access.

Abortion is legal in Massachusetts up to at least 24 weeks of pregnancy, and later in certain circumstances. State officials and health care providers have pledged to safeguard the full range of abortion care for residents, including medication abortions in the first 10 weeks.

Massachusetts Gov. Maura Healey announced the state had procured a stockpile of mifepristone.

“We will continue to use every power available to us to ensure that radical judges elsewhere in the country cannot limit access to safe, effective abortion care here in Massachusetts,” Healey said in an email.

- See the full AP story; additional material from WBUR.

Massachusetts families who get money for food from the Supplemental Nutrition Assistance Program (SNAP) will get an extra payment this week. Thanks to a $389 million supplemental budget signed by Gov. Maura Healey last week, state officials say local SNAP recipients should have received the first of three boosted snap payments from the state on April 7..

Following the expiration of a federal program that boosted SNAP payments during the pandemic by an average of $150 in Massachusetts, the state is sending local recipients about 40% of the previous boost for the next three months to provide "an offramp to the abrupt end" of the extra payments.
(That's in addition to the average $323 monthly SNAP benefit.)
Officials say the state boost averages out to an additional $60 a family each month, with a bare minimum amount of $38.

The other two payments will go out on May 2 and June 2.

- From: From food trucks to food stamps, WBUR Today, April 3, 2023.  

As of Friday April 7 all SNAP applicants must have an interview with DTA for their application to continue. An interview is a conversation with a DTA case manager to talk through the SNAP application, share the program rules, clear up missing or confusing information, and more. 

Since the pandemic began, DTA has had a federal COVID option in place to waive the interview for certain applicants. DTA re-started application interviews for all applicants on April 7. Up until now, applicants who had all mandatory information on file had their interview waived. 

Here is what you need to know, including core interview rights:

• The interview can be done by phone or in-person - whichever the applicant prefers. 
• DTA has reminded staff that applicants have a right to have their interview at a local office if they want or need to go to an office - for example, because they can’t get through the phone line, they don’t have a phone, or they prefer to meet with someone at the office. All SNAP applicants have a right to an interview in-person if they want one. 
• DTA must schedule and try to do the interview within 7 days of the date of the application to screen for expedited SNAP (emergency SNAP DTA must issue to certain households within 7 days). If the applicant applies in person, DTA should do the interview at that same time to check for expedited SNAP eligibility (and get the applicant an EBT card if they need one). 
• If an applicant misses a scheduled interview call, DTA must send out a Notice of Missed Interview. 
• An applicant can affirmatively call DTA or go to an office to do an interview at any time - they don’t have to wait until the scheduled interview. If someone calls DTA for an interview, the worker should do the interview then. They should not reschedule it and tell the client to wait for a rescheduled time. 
• If there is no interview within 30 days from the date of the application, DTA will deny the SNAP application. 
• The Recertification interview is still waived for all SNAP households. 

- From DTA update: As of 4/7, all SNAP applicants must have interview, Victoria Negus, MLRI, April 10, 2023.

The Biden administration is proposing new rules that would allow immigrants covered by the Deferred Action for Childhood Arrivals (DACA) program to qualify for health insurance through Medicaid and Affordable Care Act marketplaces.

The plan would benefit up to 580,000 young people brought to the United States as children. The expansion would rely on a regulatory change the Health and Human Services department proposed Thursday that turns on two words: who has “lawful presence” in the country for purposes of being eligible for Medicaid, the Children’s Health Insurance Program, and ACA marketplaces, which widens that umbrella to include DACA participants.

Until now, ACA insurance marketplaces have been closed to DACA participants. Those marketplaces are designed for consumers who do not have access to affordable health benefits through a job, and they provide federal subsidies to most of the 16 million people who currently have private health plans through these insurance exchanges.

Medicaid is the nation’s largest public insurance program, run jointly by the federal government and states. It provides coverage to about 85 million low-income people. It has not included DACA recipients, but several states have used their own money to permit similar coverage to people who entered the country under DACA. In addition, 18 states (including Massachusetts) have adopted an option, available for about two decades, to provide prenatal care to people regardless of their immigration status, according to data from the Kaiser Family Foundation, a health policy organization.

DACA recipients are already eligible to apply for emergency Medicaid, which pays for emergency medical treatment for people who meet their state's Medicaid eligibility requirements but not citizenship and immigration status requirements.

Such changes in federal regulations often take considerable time, with months-long periods for public comments. But a statement from the White House says: “We recognize that every day counts” and predicts “we expect to get this done by the end of the month.”

The effort to make health coverage more accessible to these young people is part of a sharp reversal on immigration policy between the Biden administration and its predecessor.

The Trump administration sought unsuccessfully to dismantle the program, which was created in 2012 during the Obama era and protects people — known by its advocates as ‘’Dreamers’' — who entered the United States as children and remained here unlawfully.  The program doesn't lead to permanent status. President Biden has been pressing Congress to create a path to citizenship for this group — unsuccessfully so far. In the meantime, the administration has been trying to use levers of executive power to widen the range of federal programs in which DACA participants are entitled to take part.

“We’re not done fighting for their pathway to citizenship, but we’re getting them the opportunities they deserve in the meantime,” Biden said in a tweet Thursday.

The future of DACA is pending in a federal court in Texas.

US District Judge Andrew S. Hanen ruled in 2021 that the DACA program was unlawful, agreeing with Republican plaintiffs that Obama had lacked the authority to create the program without an act of Congress. Hanen barred the government from accepting new applicants but has allowed existing participants to renew their work permits for now.

The Biden administration issued a rule last year in an effort to preserve DACA, but Republican states have asked Hanen to also declare that unlawful and to gradually bring the program to an end.

- See the full Boston Globe article and NPR story.

The Biden administration has announced the launch of a program aimed at giving uninsured individuals access to COVID-19 vaccines and treatments as the end of the national public health emergency nears and the financial obligations of covering these medicines shift to the private sector.

The Department of Health and Human Services (HHS) announced the “HHS Bridge Access Program For COVID-19 Vaccines and Treatments Program” on Wednesday, describing it as a “$1.1 billion public-private partnership” to provide coronavirus treatments to the uninsured.

The national public health emergency declaration for the COVID-19 pandemic is scheduled to end on May 11. As the U.S. transitions out of the pandemic era of SARS-CoV-2, private health insurance companies are expected to take on the cost of vaccines.

HHS acknowledged this incoming transition and laid out two parts of its uninsured vaccination program.

First, the department will make use of preexisting safety net programs implemented by local health departments and the Health Resources and Services Administration. Under this plan, the Centers for Disease Control and Prevention will purchase COVID-19 vaccines at a discount and distribute them through state and local health departments.

Secondly, HHS stated it plans to establish contracts with pharmacies that will allow them to continue to provide coronavirus treatments like Paxlovid free of charge to the uninsured. The federal program will provide pharmacies with per-dose payments for vaccines and treatments.

“In return for alleviating manufacturers of this administrative burden and the expense of working directly with pharmacies, HHS expects that manufacturers ensure vaccines will be made readily available directly to pharmacies that participate in this effort and that manufacturers’ patient assistance programs will provide appropriate reimbursement or replacement for COVID-19 vaccines,” HHS said.

The drugmakers have said they plan to provide vaccines to uninsured consumers through their respective patient assistance programs. During a recent hearing held by the Senate Committee on Health, Education, Labor and Pensions, lawmakers pressed Moderna CEO Stéphane Bancel to make sure that the process for uninsured to obtain vaccines was not complicated to the point of being prohibitive.

- See the full The Hill article.

When the COVID-19 public health emergency ends in the US on May 11, you’ll still have access to a multitude of tests but with one big difference: Who pays for them. For the first time, you may have to pick up some or all of the costs, depending on insurance coverage and whether the tests are done at home or in a doctor's office.

But there’s still time to get some free tests before the May 11 change, and there could still be free ones available afterward. Some state and local governments may continue to distribute free home tests through clinics, libraries and community centers. And the federal government, for now, is still sending free tests through the US Postal Service to households that haven’t already received two shipments.

And don’t discount those old tests you haven’t used. The expiration date on the package may have been extended. The Food and Drug Administration’s website provides a list to check and see which tests are still good.

Here's a look at what the end of the government's emergency declaration on May 11 means for testing:

Since early 2021, the federal government has required all private insurers to cover up to eight COVID-19 tests per month. That requirement will soon go away. Coverage is also scheduled to lapse for tens of millions of seniors in the federal government’s Medicare program, though some members of Congress are pushing to extend the benefit. And some Medicare Advantage plans may choose to offer this benefit.

While some private insurers may continue to cover all or some home tests, there will be no longer be a nationwide rule. In Massachusetts Blue Cross Blue Shield of Massachusetts, Tufts Health Plan and Harvard Pilgrim Health Care have told WBUR they have decided to end this benefit. Beginning May 12, the insurers will cover only the costs of COVID tests ordered by clinicians.

One exception will be for those enrolled in the government Medicaid program for low-income individuals and families, who will continue to receive free tests until September 2024.

In-office tests

Americans can also expect to pay more for any COVID-19 tests performed at a hospital, clinic or doctor’s office.

Insurers have been barred from charging copays, or any other cost-sharing fees related to COVID-19 testing. That requirement also ends next month.
While insurers will still cover basic testing costs, some people could face new fees for a portion of the test’s price or for the services of the health professional performing it.

COVID-19 vaccines and drugs will remain free because they are not paid for through insurance, but by the federal government. One concern is that uncertainty around testing costs could lead to delays in treatment. Current treatments for high-risk patients, like Paxlovid, generally need to be taken within the first few days of symptoms to be effective.

If people are worried about testing costs, "they may wait a couple days to see if things clear up and miss that five-day treatment window,” Christina Silcox, of the Duke Margolis Center for Health Policy said.

Testing capacity

The US struggled to build up its test manufacturing capacity during the first two years of the pandemic, with demand waning after each surge. Experts worry that the country could again be caught flat-footed after the federal government stops purchasing tests in bulk.

“Those bulk purchases basically guaranteed the market for test manufacturers,” said Jennifer Kates, a senior vice president with the nonprofit Kaiser Family Foundation.

“That upfront guarantee by the federal government that takes care of testing volatility won’t be there anymore,” Kates said.

Testing technology

The hundreds of different COVID-19 tests authorized by the Food and Drug Administration over the last three years will remain available after May 11. That’s because the FDA OK'd those products under a separate emergency measure that isn't affected by the end of the national declaration.
Still, FDA officials have been encouraging test makers to apply for full regulatory approval, which will allow their products to stay on the market indefinitely. Last month, the FDA formally approved the first rapid COVID test.

- See the full Boston Globe article and WBUR story.

President Biden has signed an executive order to boost compensation for care workers, support family caregivers, and expand affordable care options through 50 directives to federal agencies. 

“The child care and long-term care systems in this country just don’t work well. High quality care is costly to deliver, it’s labor intensive, it requires skilled workers. Yet care workers—who are disproportionately women and women of color and immigrants—are among the lowest paid in the country, despite working in some of the most important and complex and demanding jobs,” said domestic policy adviser Susan Rice.

Rice called Biden’s order the “most comprehensive set of executive actions” that a president has ever taken to advance care.

For federal workers, the order directs agencies to work to identify which grant programs can support child care and long-term care for people working on federal projects. The Office of Personnel Management will be directed to review its subsidy policies and consider setting standards for how agencies provide child care subsides. 

Similarly, the Defense Department will work to make child care on military installations more affordable through the order.

The order directs the Department of Veterans Affairs to improve access to home-based care for veterans who require help with daily living activities. And, the Department of Health and Human Services (HHS) will be directed to streamline the process for American Indian and Alaska Native to access child care. 

It will direct HHS to increase the pay and benefits for teachers and staff of Head Start programs, which are available to children from low income households under the age of 5. Those teachers currently make an average of $35,000 annually. Also, for care workers, the Department of Labor will be directed to publish a sample employee agreement so all parties understand their rights.

There is no dollar amount associated with the executive order because it will look at “how do we take best advantage of the federal dollars that are already being spent in the child care space … to make sure that they actually go to address some of the challenges,” according to a senior administration official.

The order directs HHS to issue guidance to improve the quality of home care jobs, including by leveraging Medicaid funding so there are enough home care workers for seniors and people with disabilities on Medicaid. And, the agency will be directed to consider testing a new dementia care model that will include short-term help to give a primary family caregiver a break.

Biden’s fiscal year 2024 budget called for investments to support high-quality, affordable child care, preschool, and long-term care, and this order comes out while the White House and lawmakers are still negotiating the budget.

- See the full The Hill article.

Massachusetts notaries will step into a more digital future under a law signed by Governor Maura Healey this month.

The new law, tucked into the state’s supplemental budget, will allow documents to be notarized online and completely digitally, without requiring physical stamps and signatures. The law also repeals temporary pandemic related virtual notarization effective March 31, 2023.

The provisions of this law authorizing remote online notarization are effective on January 1, 2024 and are significantly different than those in the now-repealed rule. Additional guidance related to the acceptance of registered land documents utilizing these new remote online notarization procedures will be issued by the Land Court in advance of January 1, 2024.

Legal, real estate, and banking groups have been pushing for years for the modernization. A host of transactions that require signatures witnessed by notaries will be able to be completed online under the new law, everything from mortgage loan closings to end-of-life healthcare proxy forms, building permit applications, and fiduciary trusts.

The new law goes beyond what was allowed during COVID, when the state temporarily legalized many forms of virtual remote practices. During COVID, notaries could watch people sign documents on a video conference but the documents still had to be signed and physically sent to the notary for stamping.

To prevent fraud, the new law requires document signers to present two forms of identification and create a permanent recording of every transaction.

One benefit of the law will be increasing access to notaries who speak languages other than English. “It allows people in minority and foreign language communities to connect with the people who can assist them in completing critical transactions,” Kinsel said.

- See the full Boston Globe article.

Employees injured on the job are eligible for workers’ compensation benefits, which must be provided by employers, that cover a portion of lost income and all medical care the workers’ comp insurer deems necessary and work-related. Standard employer-sponsored health insurance doesn’t cover work-related injuries, although it may pay for treatment denied by workers’ comp.

In Massachusetts, lawyers and health care providers who deal with the workers’ compensation system describe it using words like “ridiculous,” “dysfunctional,” and “tragedy.” And much of it revolves around the fact that in Massachusetts, the reimbursement rates established for medical professionals who care for injured employees are among the lowest in the country.

Combined with the administrative hassles of using a separate billing system for workers’ comp payments, and the review process doctors’ diagnoses must undergo before treatment is approved, the low payouts mean many medical providers in the state simply won’t treat injured workers. And the delays in care can lead to worse health outcomes and longer absences from work.

Most of the occupational medicine doctors trained at the Harvard School of Public Health leave the state to practice because of the workers’ comp situation, said Thomas Winters, president of the Occupational & Environmental Health Network, who teaches at the school. The number of occupational medicine clinics dedicated to worker care in Massachusetts has dropped precipitously, he said, from more than 50 about two decades ago to only a handful today.

The state declined to respond to questions about the status of workers’ comp or if any changes are in the works.

Along with low reimbursement rates, the hassle of dealing with workers’ comp insurance is another reason medical providers shy away from taking it, said Brendan Carney, a Boston attorney who has represented hundreds of injured workers struggling to get their treatment covered, including many building trades union members. The paperwork and the review process create a mountain of red tape for busy doctors, he said.

“It’s just too much of a headache,” Carney said.

Delays in treatment can also end up costing the workers’ comp insurance carrier. Acton attorney Steven Kantrovitz represented a worker who injured his hip on the job in the fall of 2021, and a legal battle over reimbursement rates caused the surgery to be delayed until earlier this year. During that time, his client’s condition worsened, driving up the cost of the surgery by $5,000, in addition to the $65,000 in weekly benefits the insurance company had to shell out to compensate for the worker’s lost income.

“It’s moronic, but this is what happens,” Kantrovitz said.

For underserved populations, the problems are compounded. Hotel housekeepers, for example, have physically demanding jobs and tend to be first-generation immigrants who may not know how to advocate for themselves if they get hurt, said Okurowski, the occupational medicine doctor.

“That’s where this system really breaks down, is for the high-labor, low wage-earning individual,” he said. “Imagine trying to navigate this system with a language barrier. It’s just brutal.”

- See the full Boston Globe article.

On April 3, 2023, the Eastern District of New York approved a settlement agreement in Amin v. Kijakazi, a case filed against the Social Security Administration (SSA) for the harm caused to extremely low-income older adults and people with disabilities across the country who lost vital benefits because of the agency’s failure to timely process appeals and follow its own rules for processing appeals. 

The settlement provides wide-reaching relief by extending the period from 10 to 60 days during which Supplemental Security Income (SSI) recipients can file a request for reconsideration and continue receiving benefits while their non-disability appeal is pending. 

Justice in Aging created a fact sheet with important information for advocates helping clients with SSI appeals.

Read more about the case and the settlement.
Get the Fact Sheet

- From: Settlement Agreement Brings Relief for SSI Recipients in Appeals Case,Justice in Aging, April 19, 2023.

In 2020, Congress approved and funded the Homeowner Assistance Fund (HAF), which was successful in staving off evictions by distributing over $9 billion in funding to help homeowners impacted by COVID-19 cover mortgage payments, homeowner’s insurance, utility bills, and other housing expenses. And until the end of 2021, a federal foreclosure moratorium protected homeowners from evictions and foreclosures during the height of the pandemic. But, the foreclosure moratorium is over and HAF funds have run out in many states, leaving some homeowners without access to these vital resources – in Massachusetts this program is set to sunset at the end of June.

In the absence of government assistance for homeowners facing foreclosure, nonprofits can help fill the gap. One example is BlueHub SUN, a lending program that refinances or buys people’s homes and resells them back to the homeowner with a new mortgage they can afford. These types of solutions are desperately needed, as homeowner inquiries into BlueHub SUN are on an upward trend across the 11 states BlueHub SUN serves.

There’s no time to waste on government action, but in the meantime, we must depend on nonprofits.

- See the full Commonwealth Magazine opinion piece

Long before COVID-19 wreaked havoc on the health care system, Dr. Judy Korik Weinstock was already feeling frustrated.

“How can you be expected to tell a patient he or she has cancer, recommend a treatment, offer other options, and provide emotional support — all within 15 minutes — and end by telling the patient that you won’t be able to see them again for another three weeks?” she asked rhetorically, describing the limitations that seemed almost contradictory to what she believed her professional role should be.

Weinstock understands the frustration of family members seeking guidance and information in the care of a seriously ill loved one during a time of ever-diminishing resources. But every day she witnesses the other side of it, too.

“The doctors who are still working are busier than ever and are running ragged trying to see patients,” she said. “People have put off seeing doctors for years due to the pandemic and it is all spiraling.”

Weinstock, who is dual-certified in family medicine and palliative care, said that in the midst of the pandemic, she found herself “rushing between families, specialists, and patients” as she tried to glean information from her colleagues and communicate it to patients.

“Families were begging me to spend more time with them, even offering to pay me under the table, which of course I refused,” she said.

But rather than succumbing to burnout, last fall Weinstock started her own company, called Circle Advocacy, to provide personalized attention to patients and families in crisis.

While numerous social workers, nurses, and counselors strive to provide the same kind of advocacy, Weinstock’s advantage lies in the fact that she is a physician — one of only four among the 19 Massachusetts-based patient advocacy companies listed with the National Association of Health Care Advocacy. Not only can she help with communication between doctors and patients; she can research treatment options, attend doctors’ appointments with her clients, and even scrutinize their medical records — with their permission.

As president of Greater National Advocates, a nonprofit national organization that connects patients and their families with independent advocates, Bradley Schwartz agreed that the move toward patient advocacy is growing.

“Physicians are becoming more and more frustrated and are looking for more autonomy,” he said. “When they are restricted by corporate restraints and cannot treat patients the way they want to, it makes a lot of sense to go work directly on behalf of patients.”

Weinstock’s Circle Advocacy’s clients, who usually pay out of pocket for the services at an hourly rate of $300 after a complimentary consultation (two out of 10 clients she takes on are pro bono), can choose between in-person and virtual visits. Frequently, Weinstock’s cases involve dual diagnoses, such as cancer and advanced Alzheimer’s.

“Maybe the patient has been hospitalized three times with infections and the family is looking for ways to decrease those infections,” she said, describing a hypothetical but typical scenario. “Every time the patient is hospitalized, she gets confused and agitated and can’t sleep at night. But no one is in favor of giving her sleep medication. The patient has four adult kids, and none agree on what to do. Now it’s causing tension within the family. If they could just have someone look through the medical records and discuss the options, along with pros and cons, they might be able to come to some agreement. But scheduling with doctors and getting specialists to talk to each other has been difficult. So they call me. I can go through the records, help them understand what’s happening, discuss their options, and offer insight on what might happen next.”

- See the full Boston Globe article.

The wait to get a child tested for an autism diagnosis can be long and the pandemic has only made the wait even greater. Families report it can take months to years to get a diagnosis. As You Are has a team of physicians who conduct virtual evaluations for autism. According to their website, the evaluation process can be completed in three individual virtual video appointments, including a clinical interview (discussion with the physician), standardized behavioral observation and results visit.

They see kids 16 months – 10 years old and accept insurance, including Medicaid and TRICARE. Coverage may vary by state and is based on each child’s benefits plan.

Learn more:  asyouare.com

As previously reported, April 1, 2023 started the one-year period in which MassHealth has to renew eligibility for its membership including 800,000 people protected from losing coverage for the last three years. While the COVID-19 Public Health Emergency is expected to end May 11, 2023, MassHealth announced this month that it is ending some of its COVID-19 eligibility policies effective April 1, 2023 too. 

MassHealth elected an option to cut some people off sooner than it was required to do. This is something the agency had not communicated in any of the information conveyed to date in its redetermination campaign.

MassHealth released Eligibility Operations Memo 23-11 (reprinted below) ending certain policies it put in place during the COVID-19 Public Health Emergency effective April 1, 2023. 

The following policies are no longer available as of April 1, 2023.

Maintaining Continuous Coverage

Beginning April 1, 2023, MassHealth will no longer maintain continuous coverage for members if they have been successfully renewed in the last 12-months.  See State Health Official (SHO) letters, SHO #23-002, January 27, 2023, and SHO #22-001, March 3, 2022, from the Centers for Medicare & Medicaid Services.

Self-attestation for Eligibility Factors

MassHealth will no longer accept self-attestation to verify eligibility factors except as described in MassHealth regulations. Exceptions include, but are not limited to, self-attestation for pregnancy and for breast and cervical cancer treatment. MassHealth will not accept self-attestation provided on or after April 1, 2023, but will ask for additional verifications.

One-time Deductible Hardship Waiver

Hardship waivers for the one-time deductible to establish eligibility for MassHealth CommonHealth will no longer be available.  

Retroactive Eligibility for Members Younger than 65

Members younger than 65, except pregnant persons and children, will no longer receive retroactive coverage as early as the first day of the third calendar month before the month of application. Retroactive coverage will be provided up to 10 days before the date of application.

Hospital-determined Presumptive Eligibility (HPE) Periods

Members will be able to obtain only one HPE determination within a 12-month period.

Extended Timeframe to Request Fair Hearings

Members will have 60 days to request a fair hearing for concerns related to member eligibility. 

- From MassHealth ending certain COVID-19 "flexibilities", Vicky Pulos, MLRI, April 12, 2023.

As reported previously and in the preceding article, MassHealth has resumed redeterminations that were halted during the pandemic. The pandemic protection is known as the Maintenance of Effort (MOE) continuous coverage protection. Of those who were protected from losing coverage under the MOE, some were protected because they completed a renewal and were no longer eligible, but the vast majority were protected from losing coverage for administrative reasons and many of them are likely eligible.

Contrary to the message in MassHealth’s outreach materials and webinars to date, after April 1, 2023:

• MOE households who only want to update their address to be sure of getting their blue envelopes, cannot do that online. They can only update their address by calling Customer Service or sending in a letter with updated information.
• MOE households who go online and attempt to “Report a Change” will be taken to the 2023 RENEWAL, and should proceed with caution; if they complete the 2023 Renewal after April 1, 2023, the agency can send them a determination that may downgrade or terminate their current coverage, and this may happen months earlier than if they had waited for their blue envelope.
• People who want to renew early and are in the MOE group, can do it. This may be a good idea if: 1. You are 100% sure you will be eligible, and want to get the renewal out of the way, 2. You know you are no longer eligible and want your MassHealth to end so that you can enroll in ConnectorCare or sign up for your employer’s coverage outside of open enrollment.
• But for many people, the safest thing to do is to call to report an address change and wait to see if you receive a blue envelope at some time between now and March 31, 2024.

• MassHealth is planning to change the banner message that now greets MOE households who go online to tell them to - Call Customer Service if you only want to update your address and contact information or - Use “Report a Change” if you want to complete a 2023 renewal now. (Were they to call Customer Service today, they would still be greeted by a message encouraging them to update their information online).
• MassHealth members who successfully renewed their coverage in the past 12 months won’t be selected for renewal until their next 12 month anniversary. But like the MOE households, they may be terminated earlier if they report a change that makes them ineligible. 

 Have people been terminated or gotten terminated notices since April 1, 2023? Yes, but it's not the people who received a blue envelope. Very few people have been selected for renewal so far this month. In addition to situations described above, there have been terminations that don’t fit any pattern. We know some appeals are queued up at the Board of Hearings, and others have reestablished eligibility by reapplying over the telephone or supplying some verification that should never have led to a termination under the unwinding rules. An email to enrollment assisters also advised of some “inadvertent” terminations for certain people who turned 65 during the last three years and were protected by the MOE;  MassHealth has a process to reinstate them.

- Adapted from Health Update & Reminder HCWG Next Wed April 26 at 3, Vicky Pulos, MLRI, April 21, 2023.

The COVID-19 Public Health emergency ends at the end of the day on May 11, 2023. For most of the past three years Medicare’s requirement for a 3-day (technically 3 consecutive midnights) inpatient hospital stay to qualify for Medicare payment of SNF benefits has been waived. Beginning on May 12, 2023, all Medicare Fee For Service skilled nursing admissions must meet CMS’ eligibility criteria and have been admitted to an acute care hospital for 3 consecutive in-patient midnights.

Time spent in the ER or in outpatient observation status does not count towards the 3-day rule.

Some Medicaid ACO plans will continue waive the 3 midnight requirement.

Some exceptions (situations where Medicare would cover SNF):

• If one enters a Medicare-certified SNF within 30 days of leaving the hospital after a 3-day stay, and receive care for the same condition that they were treated for during that hospital stay
• If the patient leaves a skilled nursing facility (SNF) and returns to that SNF or another one within 30 days, another 3-day stay is not needed

• The patient belongs to an ACO that allows for waiver of the 3-midnight rule 
• Patient has Medicaid

Patients may not be aware that they are/were classified under Observation Status. It is incumbent on case management staff to educate patients about their status so that they can make informed choices about SNF coverage before discharge.

- Adapted from The End of the Waiver of the 3 Midnight Rule, presentation by Adam Delmolino, Mass Health and Hospital Association (MHA), April 11, 2023; additional material from related presentation by Kathy Marcinek, Baystate Medical Center, added.

This month, the Centers for Medicare & Medicaid Services (CMS) finalized proposed policy changes to Medicare Advantage (MA) and Part D that may improve equity, access to care, and information for people with Medicare.

For behavioral health, the rule changes include adding new provider types—Clinical Psychologists and Licensed Clinical Social Workers—and creating network adequacy standards for them. In addition, the rule improves access standards by clarifying that prior authorization cannot be used for behavioral health, including in emergency situations, and by establishing wait time standards for behavioral health to meet network adequacy needs.

The rule made important changes to prior authorization more broadly by clarifying that MA plans may not deny coverage for services that are covered by Original Medicare, though it may use some processes to determine medical necessity. In addition, the rule should increase public information about a plan’s prior authorization procedures and rationales, though it is unclear if this will be at a level beneficiaries will be able to use when choosing a plan.

Getting information will also be easier for people who require translated or accessible format materials. Currently, people may have to ask for these materials each time, but the new rule will treat a request as a standing order, allowing future materials to be delivered to them in the requested formats.

Importantly, the rule implements recent low-income program modifications. It effectuates the aspects of the Inflation Reduction Act which expand access to Extra Help, the low-income subsidy (LIS) that helps people pay for prescription drugs. It also makes permanent Medicare’s Limited Income Newly Eligible Transition (LI NET) Program, which provides transitional prescription drug coverage to those who need it. These critical assistance pathways will help more beneficiaries afford coverage and care.

Read the Medicare Rights Center’s comments on the proposed rule.
Read the final rule and fact sheet.

- See the original Medicare Watch story.

Massachusetts House leaders will attempt to revive and make permanent a pandemic-era renter protection law, which would bar landlords from evicting financially struggling tenants who have applied for rental assistance.

The proposal, which Democratic leaders will fold into the House’s annual budget plan they intend to unveil Wednesday, would add to a list of policy changes that lawmakers first embraced during the depths of COVID-19 and have since moved to extend — in some cases, forever — even as other vestiges of the pandemic fall away.

The emergence of the eviction protection measure, however, is unexpected. The Legislature allowed the original — but temporary — measure known as Chapter 257 to lapse at the end of March despite pleas from homeless and housing advocates to keep it in place until at least July 2024. Evictions have begun rising to pre-pandemic levels, and Chapter 257, supporters argued, was a proven way to stave off pushing potentially thousands into homelessness.

Should the House proposal ultimately be included in the budget Healey signs, it wouldn’t become law until the summer, meaning it would likely be months from now until tenants could invoke the protections.

The legislative chambers typically don’t reach an agreement on the annual budget until after the new fiscal year begins on July 1; Massachusetts is routinely among the last states, if not the last, to have its annual budget in place.

The new House proposal mirrors language from the temporary version that originally passed in 2020, extending the protection to tenants who are facing eviction for nonpayment because of “financial hardship” and have a pending application for emergency rental assistance.

Rental relief funds have dwindled in the past year. Massachusetts has also tightened requirements, and available funds, for a separate state aid program — Residential Assistance for Families in Transition, known as RAFT. In August, the Department of Housing and Community Development reintroduced a requirement that tenants show they had received a notice to quit, the first step in the state’s three-part eviction process, to qualify for RAFT. (The mandate had been removed earlier during the pandemic.)

The state RAFT program now provides $10,000 per year to tenants. Healey’s proposed budget would extend the program with nearly $163 million in state funding, an amount that her administration has framed as an “offramp” from the flood of COVID-era federal funding that had helped support residents.

But she is also seeking to lower the total that each tenant can receive, to $7,000 every two years. Pre-pandemic, RAFT allowed tenants to receive up to $4,000 annually.

It’s unclear at what levels the House intends to propose funding RAFT state Representative Aaron Michlewitz, a Democrat from the North End and the chamber’s budget chief, did not provide details, but said that lawmakers in past years have raised spending for that and other programs, including the Massachusetts Rental Voucher Program. “We hope to continue that trend,” he said.

- See the full Boston Globe article.

The city’s top energy and environmental official is sounding the alarm over competitive energy suppliers, saying the companies are targeting people in neighborhoods like Dorchester and Mattapan.

For years, the companies have sent employees to people’s doors, with a request to see residents’ energy bills and the promise of lower rates. They’ve sometimes falsely claimed to be from utilities such as National Grid or Eversource, in an attempt to get residents to sign a contract with them, city and state officials have said.

Clean Choice and Direct Energy, two competitive suppliers operating in Boston, claimed they do not engage in such tactics, when asked about what Mariama White-Hammond, a Dorchester resident who serves as Mayor Wu’s energy and environmental chief, had to say about industry practices.

People who have switched to a competitive electric supplier are paying more than if they had stayed with their service, according to a state-level analysis, and low-income residents and communities of color are disproportionately affected.

Along with Dorchester and Mattapan, the worst-hit Boston neighborhoods include Hyde Park, Roxbury, and East Boston, according to White-Hammond.

“What’s most despicable about this is they tend to target seniors, people whose English isn’t their first language, and low-income communities,” she said.

The introductory rates they quote, she said, are almost never given in writing, and while the company employees sent to people’s doors are bilingual, the contracts are in English.

“These are really underhanded techniques,” she said.

City officials have been pushing their own program, known as “Community Choice Electricity,” saying that while they also offer lower rates than utilities like Eversource, the third-party suppliers are taking advantage, White-Hammond said, by sending employees to people’s doors claiming to be from the city.

“The city will never send someone to your door to sell you electricity,” she said. “If they claim to be us, it is not true.” Residents should ask to see the person’s ID card and ask them whom they work for, she added.

For now, Mayor Wu has signed onto legislation at the State House that would ban competitive electric supply companies across Massachusetts. Attorney General Andrea Campbell also supports the bill, which the industry opposes.

Campbell’s predecessor, Gov. Healey, had issued reports laying out the higher costs of competitive electric suppliers’ contracts and pursued complaints against suppliers for “aggressive and deceptive” sales tactics, including the harassment of customers with multiple calls or home visits, where some salespeople allegedly refused to leave an elderly person’s home without a signed contract.

While attorney general, Healey reached agreements with multiple companies over deceptive sales tactics, notably with Connecticut’s Starion Energy, which was forced to pay up to $10 million after allegedly “luring” more than 100,000 Bay State residents into “expensive” contracts with high electricity rates.

White-Hammond said that when residents call City Hall complaining about the competitive electric suppliers, her office directs them to the attorney general. But the problem, according to White-Hammond, is that the contracts residents sign are often different, with a higher rate, from what the salespeople told them at the door in another language, and the companies can chalk up any dispute to a “he said, she said” matter.

“It’s kind of hard to keep up with a company that is making so much money off of people,” White-Hammond said. “We need a legislative fix. While we work on a legislative fix, we need every imam, every coach, we need every home health worker, we need everybody who engages with multiple different folks to check and make sure people are not paying for these kinds of bills.”

- See the full Dorchester Reporter article.

One of the most well-worn complaints among political watchers in Massachusetts is that the government can be, well, hard to watch. The state Legislature is one of the least transparent lawmaking bodies in the country – exempt from public records laws, with decisions often made in closed committee sessions with little revelation about who voted for or against a given piece of legislation.

Being generally outraged about local government on Twitter, Facebook, or other social media sites may be cathartic, but is perhaps not the most efficient way to push for change. Now a team of volunteers is taking a swing at making online engagement with the Legislature feel a bit more civil, structured, and achievable for individuals and organizations. 

The website MAPLE (the Massachusetts Platform for Legislative Engagement) launched this month, focused on encouraging and facilitating public testimony on legislation. The Legislature does collect and post some public testimony already, but the MAPLE group is trying to improve what they see as an imperfect system. A motivating question for the co-creators was whether the online spaces where the public gathers to express views online could “be designed better to allow us to channel our energy for productive improvements for the communities that we touch?”

standardize and demystify the testimony process, and to create an online environment that encourages thoughtful interaction. Over the next year, the team expects to expand out from allowing people and organizations to submit and follow testimony to include translations, lobbying activity, and voting records. 

Some similar sites and programs exist, but geared toward a more corporate and organizational user base. InstaTrac and the LexisNexis program State Net, for instance, are paid legislative tracking tools designed for professionals. MAPLE requires a manual sign up and approval from the administrators, but the program is free to use.

Panelists tied the current state of public engagement directly to the increasing scarcity of local news organizations. 

“We have seen an incredible erosion of local journalism over the last two decades,” Danielle Allen, professor of political philosophy at Harvard said, in part because of social media and the move to digital platforms. “There’s really significant consequences to that, because all of that local journalism was the infrastructure of democracy,” she said, not just from a reporting side but also because public notices about meetings had to be posted in local papers. Part of her hope for MAPLE, she said, is that it helps to fill that infrastructural “vacuum” for the public.

But that means people and organizations would have to use it and it would need to be on the Legislature’s radar. 

That frustration that Sanders expressed is a common one for journalists, Axios Boston reporter Mike Deehan noted. Bills will often cycle through Beacon Hill over and over, never making it out of committees for no clear reason. 

In theory, Deehan said, “this will be one more piece of ammunition to say, ‘There’s all this testimony on MAPLE suggesting that this is incredibly popular.’ Is that going to change the minds of those lawmakers? Maybe not. Is it maybe going to change the mind of some of their constituents? Hopefully.”

- From A digital push for more legislative participation, CommonWealth, April 7, 2023.

Last month, Governor Maura Healey signed a budget bill that will inject $85 million into the shelter system, which is operating beyond capacity and failing to keep pace with accelerating demand. But that infusion is likely to cover little more than half a year of costs, according to a Globe review of state payment records.

In recent months, according to the review, the state has pumped tens of millions of dollars into nearly 50 nonprofits tasked with sheltering and caring for thousands of homeless and migrant families. In February alone, taxpayers footed the bill for nearly $12 million of shelter space, office rentals, employee salaries, and, increasingly, hotel rooms the state rents at great expense because traditional shelters are full.

State officials, shelter providers, and advocates agree that sheltering families in hotels is not ideal. The locations tend to be far from public transportation, they often lack amenities for children, and they aren’t built for long-term stays.

They are also expensive. In February, the state spent $3.5 million on hotel rooms to shelter more than 400 families, it said.

And that number is expected to increase further. After a winter lull, immigration to Massachusetts is surging again, advocates said. By Monday, the number of families in hotels had already climbed to 692, according to state figures.

As the system grapples with the influx of migrants, providers and state officials find themselves turning to hotels with increasing frequency, which comes at a cost.

The state sometimes pays significantly more than market rates for hotel rooms even though it is booking in bulk, according to the payment records obtained by the Globe through public records requests.

In February, the state paid a nightly rate of $229 for hundreds of bookings at a Holiday Inn Express in Waltham that offers similar rooms to the public for less than $110.
When the nonprofit providers book hotel rooms directly, there is less clarity about the cost. The invoices they submit to the state for reimbursement do not specify how much they are paying hotel operators.

A Department of Housing and Community Development spokesperson said the agency is involved in negotiating room rates on the providers’ behalf, but declined to disclose the exact rates paid.

According to payment documents obtained by the Globe, the state directly paid for rooms at six different hotels in February, totaling about $1.6 million in charges for the month. The rates range from $130 to $260 a night, though officials say the state also pays shelter providers an extra fee to manage and staff the hotels.

Because of the urgent nature of the situation, providers interviewed by the Globe said they aren’t required to negotiate rates or get them pre-approved by

For decades, the state has placed homeless families in hotels as a last resort when shelters are full. Former governor Charlie Baker, who vowed on the campaign trail to curtail the practice, reduced the number of families sheltered in hotels from around 1,500 at the beginning of his administration to practically zero by 2021.

But a surge of migration and an increase in homelessness last year reversed that progress, as officials believed they had no viable options besides placing families in hotels as traditional shelters overflowed.

Another factor adding to the crisis: the state’s broader housing crisis. It has grown increasingly difficult, state officials say, for shelter residents to find more permanent housing they’re able to afford, even with resources such as housing vouchers and the state’s HomeBASE program, which helps families transition from shelters by providing money to cover expenses like first and last month’s rent, security deposits, furniture, and utilities.

“Massachusetts is in a longstanding housing crisis where escalating housing costs are pushing more families into homelessness and limiting options for families to exit shelter into permanent housing,” Samantha Kaufman, a spokesperson for the DHCD, wrote in a statement.

At the core of the problem, housing experts say, is the simple lack of housing stock. Focusing on reducing the number of people in shelters draws attention away from the bigger solution, they say. When communities fail to build affordable housing, they pay for it in expensive shelter options like hotels.

To achieve more housing, the state, local municipalities, and advocates need to work together on changing zoning laws and funding more assistance programs that help people leave the shelter system for good, said Rachel Heller, CEO of Boston-based Citizens’ Housing & Planning Association.

“People need safe, affordable homes,” Heller said. “Housing is core to why people are experiencing homelessness. . . . When people have a home they can afford, they don’t need shelter.”

- See the full Boston Globe article.

Unpaid utility bills are piling up in the aftermath of a costly winter for energy consumers, with hundreds of thousands of homeowners in Massachusetts racking up record levels of debt, according to a new report.

The report, released Wednesday by the Boston-based National Consumer Law Center, found more than 420,000 residential customers were 90 days or more behind on utility bills at the end of February, totaling more than $557 million.

That's a 41% increase from beginning of the COVID-19 pandemic in March 2020, according to the report's authors.

"There are still a whole lot of people who are way behind on their utility bills," said Charlie Harak, a senior attorney at the law center and co-author of the report. "But the folks who are 90 days or more behind are just in a terrible hole that they can't seem to get out of."

The largest hole is widening beneath low-income customers who get discounts on their bills, according to the report.

Overall, it was an expensive winter for energy consumers, with the combination of record-high inflation, constrained supplies, and the impact of Russia’s war against Ukraine on global oil markets all driving up the cost for natural gas and home heating oil.

"Based on past trends, we fear that we will see a higher level of arrears this year than at any point during the pandemic," Harak said. "So there could a large number of terminations this spring and summer."

- See the full Eagle Tribune article.

Many residents of Greenfield know Greenfield River Park as the local dog park. Others play softball or pickleball there. Some, like Batch, call it home.

He started camping after losing his long-term job as a cook in a restaurant that closed down a few months into the pandemic. No longer able to afford his apartment, he pitched his tent along the river. He never imagined he would still be there three years later.  

The problem is that the skills he has relied on to survive in the woods are very different from the skills he needs to get out of them. Without a car, it’s hard for him to get around to different agencies to apply for housing or even know what agencies can help him, and with what. Until this winter, the only professionals that Batch had contact with were the Greenfield police, who regularly conduct welfare checks on unsheltered people. 

“The challenges Batch faces illustrate the complexity of getting unsheltered people into permanent housing,” said Bill Miller, vice president of housing and homelessness for Clinical Support Options, the agency which will soon be managing the shelter in both Greenfield and Northampton.

Like most communities, there are no agencies in Greenfield with funding to help unsheltered people navigate the convoluted process of applying for subsidized housing. Miller plans to change all that, as he oversees an expected $23 million expansion to the shelter and its programs, including some nearby subsidized apartments. He is currently hiring housing navigators who will meet with anyone homeless and looking for housing, whether they are staying in the shelter or not. After the building expansion, the shelter will also serve as a resource center with one-stop shopping where unsheltered and other homeless folks can go to search for housing. But that expansion is months in the future.  

According to Charity Day, associate director of client services at Life Path,
wait times for the statewide housing list can vary, but range anywhere from six months to several years. Since Batch is living outdoors and chronically homeless, he may be able to get into housing sooner rather than later, but it all depends on the availability of housing units which are in low supply. 

“The lack of available units is the biggest challenge that we face getting people into housing, ” said Miller. 

After successfully facing challenges with replacing all of his personal identification documents, Batch can now fill out applications for VA subsidized housing. Both Day and Miller say that his veteran status will facilitate his search for an apartment as the wait list for VA subsidized units is shorter.

There are a few temporary options, where people can live as they wait for an apartment to become available. Congregate housing is a type of subsidized housing in which residents may share a kitchen and bathroom, or even a room. Batch isn’t interested. He says that some of the people who live in these units in and around Greenfield use drugs, and he doesn’t want to live too close to them.  

Congregate housing isn’t for everyone, Miller said. “People are individuals. What works for one person doesn’t work for another,” he said. “That all just adds to the challenge of helping these people find permanent housing.”  
Batch admits communal living isn’t his thing. The local shelter is another communal situation he steers clear of. Even in the dead of winter, he’d rather stay in a tent than in the shelter which he describes as both confining  (he cites an 8 p.m. curfew) and unruly. “People steal your things there. I can’t deal with that,” he said. 

To avoid situations that might lead to interpersonal conflicts and problems, Batch has decided to wait for a VA or state subsidized apartment in his tent, toughing it out in temperatures as low as minus eight Fahrenheit. 

He’s not alone. Across the state, hundreds of people were living outside this winter, as some nights in the western and central regions of the state dipped to record-breaking low temperatures. 

“There have always been people camping out,” said Dodge. “What’s changed is that more and more are out there all year round.”

- See the full Commonwealth Magazine article.

According to Genworth Financial, nursing homes in Massachusetts cost on average $12,623 a month for a shared room and $13,533 for a private room. That adds up to more than $150,000 a year or $445 a day. While that’s more than most individuals or families can afford, to put it in perspective, many hotels charge as much or more without providing any food or care.

These are the private-pay rates. MassHealth pays different rates for each resident and each facility based on very complex regulations. Depending on various factors, the payments can range from about $150 to $375 per day, substantially less than the private-pay rates for most residents. The Medicare reimbursement rate for skilled nursing facilities is somewhat higher, but pays for only up to 100 days following a hospitalization.

The Kaiser Family Foundation reported in 2017 that 62% of nursing home residents were covered by Medicaid. The nursing home industry claims that it loses money on these residents. The state disagrees. Which is right?

Creative Accounting

In a new report by the National Consumer Voice for Quality Long-Term Care, “Where Do the Billions of Dollars Go? A Look at Nursing Home Related Transactions,” argues that the nursing home industry’s claim of financial hardship is based on creative accounting. Essentially what they do is to break up their businesses into separate entities with each providing services to, and billing, the nursing home. The nursing home may pay rent to the company owning the building, for nursing services to a staffing agency, and even for administrative services to a management company. Based on the costs of the services, the nursing home may appear to be just breaking even or losing money, but the underlying companies may be quite profitable.

The report describes one large nursing home chain, Life Care Centers that owns more than 200 nursing homes, paying companies with shared ownership $386 million in 2018. It reports that nationwide three quarters of nursing homes participate in this practice and paid themselves $11 billion in 2015.

While Medicare requires that these and other payments be “reasonable and prudent” and that the nursing homes be “prudent buyers,” payments to related parties are neither transparent nor based on market competition. Consumer Voice concludes that “[t]his practice allows nursing home owners to portray their nursing homes are operating at a financial loss or making small profits, when in reality they are making money.”

Further, it argues that public money meant to make sure nursing home employees receive fair pay is instead diverted into corporate coffers. As a result, “[r]esidents go without care and workers are permanently underpaid and overburdened, leading to staff turnover rates at over 50% per year.”

How to Fix the Problem

Consumer Voice makes the following recommendations:

• That the Centers for Medicare & Medicaid Services (CMS) do better auditing of cost reports by nursing facilities, including information for all related parties.
• Implement a minimum staffing standard. Currently CMS only requires that the level of staffing be “sufficient,” which is a nebulous amount. It recommends 4.1 hours per resident per day as a minimum.
• Impose a minimum standard for the percentage of Medicare and Medicaid payments that must go to patient care.

What About Massachusetts?

The report does not break down how prevalent this related-party practice is for each state, so it may or may not be common in Massachusetts. But we can be pretty certain that it’s more likely to occur with for-profit than non-profit facilities. That doesn’t necessarily mean that all non-profit facilities provide better care than all for-profit ones, since the former can be badly run and the latter well managed. But non-profit facilities by definition don’t divert funds owners that could be used to pay for staff and facilities.

- From Margolis, Bloom & D’Angostino.

Newly announced limits on visas for foreign nurses threatens to further a staffing strain on hospitals, nursing homes and other major health employers.

The State Department in its May Visa Bulletin announced that nearly all the available green card slots that nurses are eligible for had been filled. Only people who applied prior to June 1, 2022 will be eligible to continue with visa interviews, even if an applicant already had a job offer in the U.S.

Those with more recent applications will have to go back in line when the quota resets in October at the start of the next fiscal year, resulting in a backlog and further delaying the entrance of new nurses into the workforce.

The U.S. is facing a major nursing shortage amid unprecedented burnout and an aging workforce, and federal estimates show the country will need about 200,000 more nurses every year through at least 2030 to fill the gaps.

“Prior to COVID we had a nursing shortage. During COVID, it’s estimated that we lost about 100,000 nurses,” said Patty Jeffrey, a registered nurse and president of the American Association of International Healthcare Recruitment. 

“If we don’t have a steady flow of these international nurses to enter the country and provide services, this is dire for our hospitals, who have become more dependent on this workforce,” Jeffrey said.

Chris Musillo, an immigration attorney and managing partner at Musillo Unkenholt, said anyone with an interview this month will still be able to enter the country either late this year, or more likely the first part of 2024. 

But as of May 1, anyone with a pending interview will have to wait until Oct. 1, when the quotas will likely reset. That creates a backlog, Musillo said.

Musillo said he’s telling hospitals that even if they have a qualified nurse candidate they want to sponsor and start the process today, the nurse won’t be allowed into the country until late 2024 or “more realistically, 2025.” 

But it’s also not just hospitals that are being impacted.

“To freeze the ability for foreign-born nurses to immigrate to the U.S. using the EB-3 visa eliminates a valuable option for bringing more qualified workers into the aging services sector,” said Ruth Katz, senior vice president of policy at LeadingAge, the association of nonprofit aging services providers. 

“This visa retrogression shuts off one meaningful workforce solution, and, ultimately, harms older adults and families who cannot access needed care and services. Without staff, there is no care,” Katz said. 

Health groups and immigration advocates are pressing for Congress to fix the problem by recapturing unused immigrant visas and giving them to nurses and physicians. But immigration politics are making passing any kind of fix difficult. 

- See the full The Hill article.