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MGH Community News |
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MGH Community News |
| June 2023 | Volume 27 • Issue 6 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Hannah Perry, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
New Family Welcome Center for Immigrant and Homeless Families The state is launching its first welcome center for families experiencing homelessness at the Brazilian Worker Center in Boston. It will “serve as a central entry point for families, especially immigrant families, struggling to access basic necessities, connecting them with essential supplies, services, and transportation to a safe place to stay,” according to the Healey administration. “We’ve seen a steady rise in shelter demand due to the rising cost of housing, more families arriving in our nation and our state from other countries, and delayed federal work authorizations,” Gov. Maura Healey said in a release. She called the need “unprecedented” and said her office is working with local and federal authorities on “long-term solutions to this crisis.” Those who need a place to stay will, for now, be directed to the Joint Base at Cape Cod, where the National Guard is making space for 60 families. Ronnie Millar, the director of strategic initiatives at the state’s Office for Refugees and Immigrants, called it a “very temporary” solution. The Brazilian Worker Center in Allston is a social services organization with a long history of working with immigrants. Reason said the organization has been working with the state and city of Boston to help 50 new migrant families with essentials at Boston Medical Center’s emergency room and in area hotels. Her organization assisted families with food and necessities, and helped them get to hotels around South Bay, Natick and Randolph. “The governor of the state asked if we could extend service we were doing a little more,” Reason said. “Instead of having new arrivals coming to ER, to go directly to the center.” While the services are “not exclusively” for immigrant families, Millar said the state has seen an increase in families coming to the commonwealth. “This has been a steady increase, you know, it all depends on what's going on at the border, and in relation to Title 42,” he said. Title 42 is a public health restriction that shut down most avenues for migrants to seek asylum in the United States, and allowed Border Patrol to turn away many immigrants at the border. It ended on May 11. The number of migrants crossing the border has dropped since, but the federal government says it is unclear if that will increase after the rain months are over in Latin America. |
Turmoil in Haiti has sent growing numbers of Haitians out of the country, as well. Reason says that many of the families she’s met are Haitian, similar to what other service providers have told GBH News. Families who need support will go through intake services for the Joint Base and will be provided with necessities like food, baby formula and diapers. In the coming weeks, the welcome center will expand to include coordination with health services , helping with enrollment in Department of Transitional Assistance programs and MassHealth.
Healey will activate 50 members of the Massachusetts National Guard to support the humanitarian operation at Joint Base, similar to what then-Gov. Charlie Baker did when migrants were sent north by Florida Gov. Ron DeSantis to Martha’s Vineyard from Texas with no warning. Details The Family Welcome Center is located at the Brazilian Worker Center at 14 Harvard Ave, Allston. Their email address is: emergency@braziliancenter.org and their phone number is (617) 817-5028. Hours are Monday through Friday: 4:00 pm – 8:00 pm and Saturday and Sunday, 12noon – 7:00pm. The Family Welcome Center will provide shelter intake services for Joint Base Cape Cod which is being used as a temporary famly shelter. - See the full WGBH story. Thanks to Karon Konner and Fiona Danaher for sharing additional information.
RAFT Decreasing Benefit Limit and Eliminating Future Rent Payments Effective July 1, 2023 In accordance with the House and Senate budget proposals for FY24, which set the Residential Assistance for Families in Transition (RAFT) benefit limit at an amount not to exceed $7,000 in any 12-month period, the Executive Office of Housing and Livable Communities (EOHLC) will be implementing a $7,000 maximum benefit limit for new applications effective July 1, 2023. EOHLC will also implement an administrative policy change at this time, no longer offering future rent payments (“stipends”). This change is being made to allow EOHLC to serve as many unique households as possible over the coming fiscal year. These changes will be in effect beginning July 1, 2023, for all new applications. There will be a 30-day transition window for this policy to take effect for pending applications. Households who apply prior to July 1 will be able to access program funds at the up to $10,000 benefit limit and a one-month stipend payment so long as their application is approved before August 1, 2023. Finally, effective July 1, 2023, the RAFT program will again serve homeowners facing homelessness and housing instability by covering mortgage arrears. (See accompanying story). - From RAFT Program Changes Effective July 1, 2023DHCD Partner Update, dhcd-housingassistance@listserv.state.ma.us, June 28, 2023.
HAF Ending – RAFT Resuming Assisting Eligible Homeowners As reported last month (The Homeowner Assistance Fund (HAF) Ending on June 30th), the Massachusetts Homeowner Assistance Fund (HAF) that has been providing mortgage relief to homeowners who are behind on their mortgage payments due to the pandemic will end on 6/30. Beginning July 1, 2023 the Residential Assistance for Families in Transition (RAFT) will once again be open to low-income homeowners who are at risk of foreclosure. Homeowners will be able to apply for RAFT through the online portal. Households facing an imminent foreclosure within the next 7 days, may contact the Massachusetts Division of Banks (DOB). The DOB may be able to request a 60-day stay providing extra time for the homeowner to seek resources and hopefully avoid foreclosure. - Thanks to Hannah Perry for submitting the original article.
New Law Allowing Undocumented Immigrants to Get Driver’s Licenses Effective July 1 The new state law allowing undocumented immigrants to get driver's licenses takes effect on July 1, 2023. The state Registry of Motor Vehicles has announced that it is hiring more staff, extending hours, and offering road test materials in 15 languages ahead of the implementation of a new law that allows people without legal immigration status to get a driver’s license. The law, dubbed the “Work and Family Mobility Act,” was passed last June after Massachusetts legislators voted to override a veto from Republican Governor Charlie Baker, who said the measure could threaten election security, among other concerns. Starting July 1 newly eligible Massachusetts residents will be able to apply for learner’s permits, take road tests, and eventually obtain driver’s licenses without having to provide proof of immigration status. Logistics Two appointments will be required for a license: one for a learner's permit test and one for a road test. As of July 1, those without legal immigration status will be able to pre-register for appointments online. (Since the RMV is closed on weekends, the first available day will be Monday, July 3.) What you'll need: All applicants have to prove they're a Massachusetts resident, along with their identity and date of birth. That means two forms of ID (such as a foreign passport and a driver's license from a different state or country), along with a residency document like a bill or bank statement. The state's website has more details on identification requirements here. (Residents without social security numbers also will have to show they've been denied an SSN or attest they never had one.) Additional services: The RMV suggests bringing a friend or family to your in-person appointments and road tests if you need an interpreter. If no one is available, you can request an interpreter for the road test on your road test application form. The Massachusetts Registry of Motor Vehicles has published a Work and Family Mobility Act webpage. For information, resources, and updates on the application process directly from the RMV, visit: http://mass.gov/WFMA.The RMV has also launched a Work & Family Mobility Act informational phone line. Call 857-368-WFMA(9362) to hear info about how to apply for a standard driver’s license. This hotline is currently available in six (6) different languages. The Driving Families Forward Coalition has put together a document checklist handout, guides and training materials in multiple languages that go through the application process. For these resources, visit: https://drivingmaforward.us/materials. Remember: Undocumented residents still can't get REAL IDs, nor can they get commercial driver's licenses. The new law only changes the rules for standard car and motorcycle driver’s licenses. The same fees apply, which add up to $115. Beware of scammers: You never need to pay for access to RMV forms. The state has put out a list of six hints to help people avoid fraud by third-party websites. Background and RMV Preparation Sixteen other states and the District of Columbia have similar laws, according to the National Conference of State Legislatures. “The Work and Family Mobility Act is a benefit for public safety, for our economy, and for our immigrant residents who should be able to drive to work, school, or the grocery store without fear,” Governor Maura Healey said in a statement. “We are grateful to the advocates, legislators, and public safety leaders who have worked so hard to get us to this point.” The RMV has spent months preparing to implement the new law. Some of the changes include:
The RMV also launched a dedicated phone line for information about the new law, with information available in English, Spanish, Portuguese, Mandarin, Haitian Creole, and Vietnamese. Healey’s office has said the cost to implement the new law will be largely offset by transactions for exams, road tests, and license fees. Under the new law, applicants will have to provide two documents that prove their identity, such as a foreign passport and birth certificate or a passport and a marriage certificate. - See the full Boston Globe article. Additional material from Prepping for the new Mass. driver's license law,WBUR Today, June 26, 2023 and Resources to Apply for a Driver’s License under the Work and Family Mobility Act, Driving Families Forward Coalition, Jun 6, 2023.
SNAP Interim Reports – Households Must Respond to Maintain Benefits “Interim Reports” are reporting forms that some SNAP households must complete about 6 months after they apply to keep their SNAP benefits going. During the pandemic, DTA waived the Interim Report for the vast majority of SNAP households. Since mid-April DTA has been sending out Interim Reports again to some people. If DTA sends someone an Interim Report, the household must complete it to keep their SNAP case open! The Interim Report can be done over the phone or on DTAConnect, or by returning the paper form through DTA Connect, by mail/fax, or in person at a DTA office. Most households do not have to do an Interim Report. The only SNAP households who have to do an Interim Report are “Simplified Reporting” households who meet certain rules (namely, who have no income/aren’t homeless and those with income within $200 of the gross income test). To understand who is on Simplified Reporting, see DTA’s overview of the certification/reporting categories. For the details of this policy change and who is subject to it, see DTA’s overview here. If the SNAP household does not complete the Interim Report, DTA must send a termination notice before their SNAP is cut-off with information on how they can fix the problem. Please let MLRI know if you see any issues with Interim Report or other issues where DTA incorrectly handles a SNAP case.. - From[FoodSNAPcoalition] End of SNAP Extra Benefits, Upcoming P-EBT Benefits & DTA Interim Reports, Victoria Negus, MLRI, June 12, 2023.
Low MA Unemployment Requires State to Reduce Maximum Length of Unemployment Benefits Recent estimates from the United States Department of Labor Bureau of Labor Statistics shows that the 12-month average local unemployment rate in each of the Commonwealth’s eight designated Metropolitan Areas is now at or below 5.1%. When unemployment falls at or below that rate, under state law, the maximum unemployment benefit period for new claimants automatically adjusts from 30 weeks to 26 weeks. This automatic benefit adjustment last occurred in March 2019. The adjusted benefit period will apply only to new unemployment claims filed on or after July 2, 2023. Claimants who have filed claims for unemployment benefits prior to July 2, 2023, will remain eligible to receive up to the 30-week maximum benefit that was in effect at the time they filed their claim. The law requires measurement of average local unemployment rates and an upward re-adjustment of the maximum benefit period if the condition of the labor market declines. The maximum benefit period that a claimant may receive would return to up to 30 weeks if, in any month during an individual’s benefit year, the unemployment rate in any one of the Commonwealth’s measured metropolitan statistical areas rises above the 5.1% threshold. More information on the adjustment, including a Frequently Asked Questions document published by the Department of Unemployment Assistance in multiple languages, can be found on its website here. - See the full press release.
TPS Extensions for El Salvador, Honduras, Nepal, and Nicaragua The Department of Homeland Security (DHS) has announced plans to rescind its prior terminations of Temporary Protected Status (TPS) for El Salvador, Honduras, Nepal, and Nicaragua and extend TPS designations for all four countries for existing beneficiaries for 18 months. DHS will publish Federal Register notices (FRNs) for the El Salvador, Honduras, Nepal, and Nicaragua TPS rescissions and extensions and provide additional information on the re-registration process. Existing TPS beneficiaries from these countries will need to re-register within specified 60 day time periods. El Salvador Honduras Nepal Nicaragua More Information USCIS will plan and coordinate outreach opportunities to provide information and answer questions from the public regarding the extension of TPS for all four countries. For the most current information related to Temporary Protected Status, visit our TPS webpage. - Thanks to Fiona Danaher for sharing this update.
Supreme Court Strikes Down President Biden’s Plan to Erase Student Loan Debt A sharply divided Supreme Court ruled Friday that the Biden administration overstepped its authority in trying to cancel or reduce student loans for millions of Americans. The 6-3 decision, with conservative justices in the majority, effectively killed the $400 billion plan, announced by President Joe Biden last year, and left borrowers on the hook for repayments that are expected to resume by late summer. The court held that the administration needs Congress’ endorsement before undertaking so costly a program. The majority rejected arguments that a bipartisan 2003 law dealing with student loans, known as the HEROES Act, gave Biden the power he claimed. “Six States sued, arguing that the HEROES Act does not authorize the loan cancellation plan. We agree,” Chief Justice John Roberts wrote for the court. Justice Elena Kagan wrote in a dissent, joined by the court’s two other liberals, that the majority of the court “overrides the combined judgment of the Legislative and Executive Branches, with the consequence of eliminating loan forgiveness for 43 million Americans.” Loan repayments are expected to resume by late August under a schedule initially set by the administration and included in the agreement to raise the debt ceiling. Payments have been on hold since the start of the coronavirus pandemic more than three years ago. (See next story.) The forgiveness program would have canceled $10,000 in student loan debt for those making less than $125,000 or households with less than $250,000 in income. Pell Grant recipients, who typically demonstrate more financial need, would have had an additional $10,000 in debt forgiven. Twenty-six million people had applied for relief and 43 million would have been eligible, the administration said. The cost was estimated at $400 billion over 30 years. - From the Boston Globe.
Student Loan Repayments Set to Resume After 3-Year Pause The House of Representatives has reached an agreement with the Biden administration to lift the student loan repayment moratorium by the end of the summer as the U.S. Supreme Court is gearing up to release a ruling on the legality of President Biden’s student debt forgiveness plan. A deal struck between President Joe Biden and House Speaker Rep. Kevin McCarthy On Wednesday, May 31, voted to raise the country’s debt ceiling before a default and also included an adjustment to the administration’s effort to provide student loan relief and aid to millions of borrowers. Student loan payments have been paused for the past three years since the start of the COVID pandemic. During this time, Republicans have attempted to resume student loan payments, which Biden has repeatedly extended. As part of the debt ceiling bill, Biden agreed to restart all student loan payments after Aug. 30, two months after the Supreme Court is expected to release its ruling on Biden’s debt relief plan. “This bill does end the payment pause,” Shalanda Young, director of the Office of Management and Budget, said in a press briefing. “But very close to the timeframe we were going to end it, as an administration, when it comes to repayment.” There is no definitive plan on what the restart process yet looks like for student borrowers, the pause is set to expire 60 days after the Supreme Court ruling. Which was just announced today (June 30, 2023). Student loan repayment dates may also vary from borrower to borrower. Student borrowers interested in knowing when they should resume their student loan payments can look toward the Federal Student Aid website for loan counselors. Counselors can look at an individual’s financial and employment history and let them know what repayment plan works best and whether they should wait out the 0% interest loan moratorium period. Organizations such as the Student Borrower Protection Center and the Institute of Student Loan Advisors are also useful tools for student loan borrowers. The Biden administration wants to waive $10,000 to $20,000 in debt for over 44 million American student loan borrowers. However, the legality around Biden’s authority to erase student debt is currently being considered by the Supreme Court. - From MassLive.
MassHealth Rolls Grew During First Redetermination Month More than 12,000 people left MassHealth coverage in April, and top state officials expect those numbers to grow significantly in the coming months as the process of redetermining eligibility for about 2.4 million Bay Staters ramps up. The Healey administration on Thursday outlined a new digital dashboard summarizing data from the first month of the redetermination process, which will decide how many people can remain on publicly-funded health insurance for the first time since the COVID-19 pandemic began. About a third more people fell off the MassHealth rolls in April than in March, but despite the early impacts, overall enrollment saw a net increase because about 18,700 people joined the insurance program over the course of the month — a tally officials described as relatively routine. Assistant Secretary for MassHealth Mike Levine described the topline MassHealth growth in April as “a little bit counterintuitive.” Impacts from the gargantuan effort to figure out who is still eligible might not become clear for several more weeks because of the lag time involved in the first batch of redeterminations, Levine said. “There’s not a lot to see in April because we were just getting started and we took a very measured approach in April to begin to select members for renewal,” Levine told reporters. “But if you got selected for renewal as a MassHealth member in April, if you do not respond or you respond but it takes us a while to process, you’re not going to see a coverage impact until more like the late May, early June timeframe.” If a MassHealth recipient got selected for redetermination review on April 15, Levine said, the “blue envelope” mailed to them signifying that status might not arrive until April 20. Most members then get 45 days to respond to the state, plus another 90 days if MassHealth decides it needs more information, pushing back the decision date for future coverage status by several weeks. Roughly 7,000 Bay Staters who lost MassHealth coverage enrolled in Massachusetts Health Connector plans, many of which are subsidized, since the redetermination process started, according to data published by the Connector. Early estimates pegged the number of Massachusetts residents who will lose MassHealth coverage at between 300,000 and 400,000, and Levine said it’s “too early to say” if the early data will alter those projections. The total MassHealth enrollment in April of 2.41 million is nearly 660,000 people larger than enrollment in February 2020, before COVID-19 hit. State budget-writers are counting on the process of redetermination to free up about $1.9 billion to spend elsewhere in fiscal year 2024, which begins July 1. Over the course of April, the state opened redetermination cases for about 108,000 of MassHealth’s 2.4 million enrollees. MassHealth plans to launch about 150,000 more redeterminations per month to tackle the full field within a year, as required by federal law. Levine said the administration hopes to publish data covering the month of May by June 20. Levine said state officials are taking steps to support older residents, especially those who live in long-term care facilities, during the redetermination process. The “most important thing” older Bay Staters can do, he said, is ensure they have an authorized representative such as a family member or the facility where they reside. “Every time then when we send a notice or renewal form to that individual, we send a carbon copy to the authorized representative or designee,” Levine said. “ Levine said older adults can also call the MassHealth customer service line, (800) 841-2900, and fill out their applications over the phone “with a trained and experienced customer service representative.” Last week, the Healey administration announced MassHealth would direct $1.25 million in grant funding to 23 organizations to help train more counselors that will assist with renewals. - See the full WWLP.com story.
Updated Housing Code Checklist The Department of Public Health made important updates to the State Sanitary Code that went into effect on May 12, 2023. The State Sanitary Code is a critical regulation designed to affirm all Massachusetts residents' right to safe living conditions. To help people understand the Sanitary Code, MLRI has updated our Housing Code Checklist. The checklist is a practical tool to help tenants identify what is wrong in their apartment and what steps to take to get repairs made The Housing Code Checklist is now available in English, Spanish, and Portuguese on MassLegalHelp. An excerpt from the checklist “In addition to this checklist, you can use Up to Code, a website that can help you document problems and notify your landlord about the problems. Go to: madeuptocode.org. - From New from Mass Law Reform, Massachusetts Law Reform Institute, June 15, 2023.
DTA Announces SNAP/Restaurant Meal Program - Going Live in the Fall The Healey-Driscoll Administration has announced that 27 restaurants and food trucks have been selected to participate in the Supplemental Nutrition Assistance Program (SNAP) Restaurant Meals Program (RMP) pilot and anticipates the program will open for certain individuals and households to use their benefits at selected restaurants and food trucks by fall 2023. Under federal rules, the RMP allows individuals with disabilities, households with older adults aged 60 and up, and individuals experiencing homelessness to use their SNAP benefits at select, participating restaurants and food trucks that offer reduced-price meal options. This program will expand food choice options and food access points for populations that may encounter barriers and challenges with purchasing and storing groceries, as well as cooking and preparing meals for themselves. “These selected restaurants and food trucks are diverse and strong focal points in their communities, dedicated to providing their neighbors with access to delicious and healthy food that is also nourishing and familiar to people from around the world. This approach to the SNAP Restaurant Meals Program pilot centers on serving low-income individuals and families to help address nutrition, health, and economic inequities.” said Secretary of Health and Human Services Kate Walsh. Eligible businesses in this pilot phase of the program include restaurants and food trucks that are local and privately-owned and provide counter-based service and payment. Of the selected local businesses, 77% are women-owned and 90% have owners who identify as Black, Asian and/or Hispanic/Latinx. The average meal price is $11. Applicants were evaluated on criteria including their ability to respond to the needs of prioritized communities and eligible populations, inclusive of areas where food insecurity and rates of chronic disease have historically been disproportionately high, and areas classified as food deserts and environmental justice neighborhoods with limited existing access or other food access barriers. Restaurants were also evaluated on their ability to provide healthy and reduced-price food options, as well as their commitment and ties to their local communities, including their ability to serve SNAP clients in culturally appropriate ways. The selected restaurants and food trucks will serve individuals and households across 16 communities in Massachusetts: Restaurants:
Food Trucks:
Restaurants/Food Trucks:
Learn more about the RMP pilot program at Mass.gov/SNAPRestaurants. - See the full press release.
MassHealth Continuous Coverage for Formerly Incarcerated People and People Experiencing Homelessness Massachusetts has requested and received federal approval for a MassHealth waiver that will allow extended “continuous coverage” for formerly incarcerated people and certain people experiencing homelessness. The waiver is approved through December 31, 2027. Continuous coverage means that once someone is found eligible for MassHealth, they will remain enrolled in MassHealth for the duration of the continuous coverage period regardless of changes in circumstances. In other words circumstances that typically lead to loss of coverage (increases in income, missing paperwork/deadlines, etc.) would NOT impact coverage during the time period for their group and during the waiver period - through December 31, 2027. The demonstration approves continuous eligibility for two groups: 12-months continuous eligibility for people re-entering the community from incarceration and 24-months continuous eligibility for people who have been confirmed as homeless for 6+ months. They will receive the benefits of the Medicaid eligibility group according to their most recent eligibility determination An individual will not be eligible for continuous coverage if:
Justice Involved Individuals As of April 1, 2023 people re-entering the community from incarceration will have 12 months of continuous eligibility. Eligible Populations: MassHealth eligible individuals under age 65 released from a correctional institution. Including County Correctional Facilities (CCFs), State Department of Corrections (DOC) Facilities, and Department of Youth Services (DYS) juvenile justice facilities Duration of Continuous Eligibility: 12 months following release date
Existing procedures notify MassHealth when a member is in custody or is being released. People Experiencing Homelessness Effective December 1, 2023 people who have been confirmed as homeless for 6+ months will have 24 months of continuous eligibility. Eligible Population: MassHealth eligible individuals under age 65 with a confirmed status of homelessness for at least 6 months. Confirmed status of homelessness” is verified through Statewide Homeless Management Information System and/or from the Department of Housing and Community Development, Emergency Assistance shelter system for families. Duration of Continuous Eligibility: 24 months The 24-month continuous eligibility period for individuals experiencing homelessness will begin no later than the third month before the month of application or on the effective date of the most recent renewal of eligibility. 12 Month Verification: 12 months into the 24-month continuous eligibility period, MassHealth will make a reasonable effort to confirm that the individual still meets the continuous eligibility criteria before resuming the remainder of the 24-month eligibility period. MassHealth will utilize available data sources and standard member outreach procedures in an attempt to verify information. The termination of continuous eligibility would only result in the event of a response affirming out of state residency, death or voluntary withdrawal. Mail being returned or undelivered will not result in a termination of benefits or an interruption in the continuous eligibility period unless there is sufficient evidence indicating reason for termination. Ending the Continuous Eligibility Period At the end of the continuous eligibility period, MassHealth will attempt to automatically renew coverage. If they are unable to autorenew, a request for renewal will be sent to the member. If a member does not submit a completed eligibility renewal following the end of the continuous eligibility period, benefits will be determined based on available data sources during a “systematic program determination”. Additional Sources and for More Information CMS, MassHealth Demonstration 1115 Waiver Approval Letter (September 28, 2022): https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ma-masshealth-ca1.pdf. CMS, Continuous Eligibility Implementation Plan (May 19, 2023): https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ma-masshealth-ca-demstrt n-aprvl-05192023.pdf. If you have any questions about continuous eligibility or are interested in more information on MassHealth for justice-involved individuals, advocates can email Isabel Wanner at iwanner@mlri.org. - From: MassHealth Updates: Continuous Eligibility, Isabel Wanner, MLRI, (undated).
New MassHealth MyServices Portal On June 1, 2023, the state launched a new MyServices Portal for all MassHealth members. The MyServices portal is a new member web portal designed for all applicants and members to:
Additionally, MyServices is:
Note, MyServices is only available to members and applicants and cannot be accessed by ARDs, PSIs, or Certified Assisters. Members and applicants can learn more about MyServices at Learn about MyServices | Mass.gov or the MyServices FAQ (scroll down for the information sheet- available in 6 languages). Members or applicants with technical problems using MyServices in their web browser should try to clear the browser’s memory, also known as the cache. Learn how to clear a browser’s cache at https://www.mass.gov/guides/clear-your-browser-cache. For all other questions, contact MassHealth Customer Service at 800-841-2900; TTY 711. - From NEW MyServices Portal, Massachusetts Health Care Training Forum, June 1, 2023.
The Inflation Reduction Act’s Medicare Part B Insulin Price Takes Effect July 1 The Inflation Reduction Act (IRA) capped out-of-pocket costs for insulin medications for people with Medicare. Coinsurances and copays for insulin covered under Part D have been limited to $35 a month for a month’s supply of each medication since January 1. Starting Saturday, July 1, beneficiaries whose insulin is covered under Part B will also enjoy these protections. Medicare covers insulin and insulin containing products in two ways depending on how the medicine is administered. Insulin used in conjunction with a covered infusion pump is covered through the Durable Medical Equipment (DME) benefit under Part B. All other insulin is covered under Part D, including insulin that people inject using syringes, fillable or pre-filled pens, or non-durable patch pumps. A recent report from the U.S. Department of Health and Human Services (HHS) indicates Medicare beneficiaries would have saved $734 million in Part D costs and $27 million in Part B costs if the IRA’s insulin cap had been in effect in 2020. Specifically, the report notes that around 31,000 people with Part B would have saved money if the IRA’s provisions were in effect in 2020, savings of about $866 per beneficiary. Prior to the IRA’s changes, the national average out-of-pocket cost for a month’s supply of insulin for people with Medicare or private insurance was about $63 per fill. Learn more at Medicare Interactive from the Medicare Rights Center. - From Medicare Watch, the Medicare Rights Center, June 29, 2023.
Expansion of Medicare Part D Low Income Subsidy For many low-income Medicare beneficiaries, the Part D Low-Income Subsidy (LIS) program (also called “Extra Help”) can be a lifeline, helping them afford needed prescription drugs. Under the Inflation Reduction Act (IRA), more enrollees—those with incomes between 135% and 150% of the federal poverty level (FPL)—may qualify for full assistance beginning January 1, 2024. Currently, LIS has two benefit tiers: full and partial. Each offers different levels of assistance, based on beneficiary income and assets:
Beginning in January, the IRA eliminates the partial LIS benefit and extends the full subsidy to that cohort. As a result, in 2024, Medicare beneficiaries with incomes below 150% of poverty and assets within the partial LIS limits can qualify for access to Part D plans with no premiums or deductibles and modest co-pays. This shift will save the estimated 400,000 Part D enrollees currently receiving partial LIS benefits, a disproportionate number of whom are Black and Hispanic, $300 per year on average. Enrollees who take expensive specialty drugs, for whom the partial subsidy’s coinsurance could be particularly burdensome, may see even greater savings. Medicare Rights applauds recent efforts by the U.S. Department of Health and Human Services (HHS) to reach these individuals and improve LIS uptake. Strategies unveiled this week include new data on beneficiaries likely eligible for but not enrolled in Extra Help; an outreach toolkit, including social media content – PDF and a consumer-friendly article – PDF; and a dedicated Extra Help webpage on Medicare.gov. Read the HHS Fact Sheet, Biden-Harris Administration Announces New Tools to Lower Prescription Drug Costs for Low-Income Seniors and People with Disabilities - See the full Medicare Rights post.
Medicare Reminder: Skilled Nursing Facility (SNF) Coverage Basics Skilled nursing facility (SNF) care is post-hospital care provided at a SNF. Skilled nursing care includes services such as administration of medications, tube feedings, and wound care. Keep in mind that SNFs can be part of nursing homes or hospitals. Medicare Part A may cover your SNF care if:
Note: The day you become an inpatient counts toward your three-day inpatient stay to qualify for Medicare-covered SNF care. However, the day you are discharged from the hospital does not count toward your qualifying days. Also remember that time spent receiving emergency room care or under observation status does not count toward the three-day hospital inpatient requirement for SNF coverage. If you meet all of the above requirements, Medicare should cover the SNF care you need to improve your condition, maintain your ability to function, or prevent your health from getting worse. Speak to your doctor or hospital discharge planner if you need help finding a SNF that meets your needs. Ask them to find Medicare-certified SNFs in your area that will address your medical needs. If you are in a Medicare Advantage Plan, contact your plan to find out which SNFs are in their network. - From Medicare Watch: Medicare Provider Overpayments Problematic and Point to Larger Issue, Medicare Rights Center, June 22, 2023 and at: https://www.medicareinteractive.org/get-answers/medicare-covered-services/skilled-nursing-facility-snf-services/snf-basics
Medicare Reminder: How Medicaid Works with Medicare All states offer a variety of Medicaid programs, with eligibility and coverage specifics varying by state. If you qualify for a Medicaid program, it may help pay for costs and services that Medicare does not cover. Here are a few examples of how Medicaid can work with Medicare.
Make sure to call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are a dual-eligible. - From Medicare Interactive, from the Medicare Rights Center.
The Home Health Aide Crisis “We are in a crisis and I’m in panic mode,” the woman e-mailed me recently. She was desperately looking for a home care worker for her husband, who has ALS. “I didn’t realize it would be this hard to find help.” I didn’t either, having dared to hope that things had improved in the home health care sector. In 2018, after a yearlong investigation, I wrote a series for the Globe called Stranger in the House, drawn from my own harrowing experience hiring workers after my husband’s ALS diagnosis. The industry meant to support our frail and aged was in a state of crisis—almost chaos—marked by a lack of regulation and a severe shortage of workers. Hiring aides through agencies is impossibly expensive for most people—it’s not usually covered by insurance—so many people turn to the unregulated, poorly-trained but more affordable “gray market” of freelance aides which, I discovered, was rife with fraud, neglect, and abuse. Duke University professor Donald H. Taylor Jr. called it “the biggest public policy issue facing our country that no one is talking about.” And MIT professor Paul Osterman, who wrote a book about the long-term care force, told me then that the situation was “an absolute train wreck waiting to happen.” COVID-19 piled onto that train wreck. After the pandemic struck, reports on the home-health crisis were filed, rallies held, petitions signed. Federal legislation to improve coverage for home care services was even introduced. Last year, Congress passed the legislation—without the part about home care services. The dangers of COVID-19 made home care work less attractive to workers, and opened up far less physically and emotionally demanding jobs. “It’s the most high-need consumers struggling the most in finding workers,” says Rebecca Gutman, vice president of home care for Local 1199 of the Service Employees International Union. “Ultimately, people will decide to work for the person who needs a lower level of care.” In March, union members held a rally at Governor Maura Healey’s office, pressing for higher pay, better benefits, and more training. Without sufficient staffing, home health agencies are turning away vast numbers of patients referred to them by hospitals. The so-called rejection rate was 76 percent in January, according to WellSky, a technology company that serves 130,000 home health care agencies and social service providers. This means hospital patients are waiting longer to be discharged because aides aren’t readily available to provide support. Meanwhile, the old problems haven’t gone away. Demand for aides has increased as baby boomers are aging, and more seek to age in place. Salaries for caregivers, who are often immigrants from Africa and the Caribbean, haven’t kept pace. The mean annual wage for home health and personal care aides was $14.87 an hour, or $30,930 a year, in May 2022, according to the US Labor Department. The average hourly wage at Walmart is over $2.50 more, for work where the stakes aren’t usually life or death (Massachusetts is a “leader” in pay, which isn’t saying much: personal care attendants funded by MassHealth get $18 an hour). Medicare law authorizes up to 35 hours a week of home health aide services but it’s rarely obtainable, adds Kathleen Holt, associate director of the nonprofit Center for Medicare Advocacy. She says the responsibility for figuring out how to pay agencies to make that happen lies with the federal Centers for Medicare & Medicaid Services. “Home care agencies get a flat payment for 30 days per patient,” she says, and each agency gets to decide which services they will provide — nursing care, physical therapy, speech therapy, or something else. Labor-intensive services like bathing, dressing, and feeding often get left out of the mix. “They may come and do an assessment, but they’ll say they don’t have the staff to provide the services.” - See the full Boston Globe magazine story.
Many Older Adults Face Unpaid Medical Bills Despite Insurance Coverage This month, the Consumer Financial Protection Bureau (CFPB) Office for Older Americans released an issue spotlight on medical billing and collections showing that many older adults have unpaid medical bills and are in collections. This is despite most older adults having health insurance coverage, including Medicare and Medicaid. The findings reveal that these bills are often the result of improper and inaccurate billing. According to the CFPB data, most people aged 65 and older have health insurance (98%). But nearly four million had medical bills that they were unable to pay in full in 2020. The highest incidence (13%) was among those without insurance, and the lowest was for those with Medicare plus employer-sponsored coverage (4%). Over two-thirds of those with unpaid bills (70%) had coverage from more than one source such as Medicare, Medicaid, Medigap, employer-based coverage, or Tricare. While the incidence of unpaid bills is lower for older adults (7%) than younger ones (11%), probably due to near-universal Medicare coverage, the dollar amount unpaid is increasing. In 2019, older adults reported $44.8 billion in debt; in 2020, that number rose to $53.8 billion. Those with unpaid bills were more likely to be older adults of color, to be in poor health, to have other debts, or to have incomes between 100 and 200% of the federal poverty level. CFPB flags inaccurate billing as one of the main drivers of unpaid bills, showing that older adults are more likely to have numerous chronic health needs, conditions that are billed at a higher intensity which require greater documentation, and to rely on coverage from multiple sources. This combination can lead to delays in payment, errors in who is billed for what services, and providers seeking inappropriate reimbursement from patients. People who are dually eligible for Medicare and Medicaid see disturbingly high levels of unpaid medical bills. Most dually eligible individuals should have little out-of-pocket exposure to medical costs, but they report both higher incidence of unpaid bills and higher dollar figures for the bills than their non-dual counterparts. CFPB notes that this suggests providers are billing beneficiaries for amounts they do not owe. Unpaid medical bills cause personal and financial stress, landing people in collections and having negative effects on credit ratings. Recently, the three major credit bureaus stopped reporting cleared medical debt, medical debt in collection below $500, or medical debt in collections for under one year. But this does not alleviate the stress of unpaid bills or eliminate collections activities. At Medicare Rights, we urge CFPB, Medicare, and policymakers to do more to protect everyone, including older adults and people with disabilities, from high out-of-pocket costs and inaccurate billing. We support limiting Medicare beneficiary spending, expanding financial assistance, educating providers about billing rules, and improving oversight of providers and insurance payers. Stronger guardrails are needed system-wide. Read the issue spotlight. - From Medicare Watch, the Medicare Rights Center, June 1, 2023.
Migrants in Boston’s Fast-Track Immigration Court are More Likely to be Ordered Deported When the Biden administration announced in July 2021 a new immigration court program in Boston, top officials promised it would make asylum cases faster and fairer for migrant families. Two years later, those promises are far from being fulfilled, according to local advocates and a new report from an immigration clinic at Harvard Law School that provides the first detailed review of Boston’s expedited program, called the “Dedicated Docket.” Migrants assigned to Boston’s fast-track program are more likely to be ordered deported, less likely to be represented by an attorney, and less likely to prevail in an asylum case compared to those who are funneled into Boston’s regular immigration court, the report found. A key problem, the report concluded, is that migrants assigned to the new program struggle to secure legal representation within an expedited timeline of 300 days to have their cases decided. What’s more, only a fraction of cases were completed quickly — fewer than 4,000 out of 20,000 cases examined by the Harvard Immigration and Refugee Clinical Program. And the vast majority of those completed cases either ended in a deportation order or were dismissed because prosecutors failed to file necessary paperwork, leaving the migrants in an undocumented limbo, the report said. “The administration has now had two years to make good on its promise of a Dedicated Docket that delivers both efficient and fair proceedings to families seeking asylum. It has failed to do so,” advocates, including the authors of the Harvard report, wrote in a letter sent to the Biden administration Thursday. The Dedicated Docket in Boston is one of 11 fast-tracked immigration programs set up by the Biden administration in major cities. It is also the country’s biggest, with between 13,000 and 19,000 pending cases as of January (the federal government and the report’s authors, who analyzed federal government data, disagree on the total number). The docket flips the usual order of immigration court proceedings on its head. Under regular circumstances, new deportation cases go to the back of the line and are scheduled based on judges’ availability, with cases already in progress getting first priority. But the dedicated docket bypasses that process, prioritizing the newly arriving families with the goal of closing their cases quickly, and sending a signal to would-be migrants that entering the United States without authorization won’t guarantee a long stay in the country as an asylum case wends through the courts. Migrant advocates have long warned, though, that such a speedy system risks rushing migrants through life-altering legal proceedings before they can find lawyers and prepare their asylum claims. For years, advocates for migrants decried similar programs implemented by Presidents Barack Obama and Donald Trump, saying they are unfair to asylum-seekers and ineffectual at reducing the country’s huge backlog of immigration cases. One issue emphasized in the report and by immigration attorneys is that many migrant families end up on the Dedicated Docket without realizing it. Notices to appear for court hearings were often sent to outdated addresses, or not at all, the report found. Then, when migrants failed to appear for hearings, judges sometimes ordered them removed from the country. The Biden administration said it chose Boston for a Dedicated Docket because of the area’s “established communities of legal service providers.” But in a letter sent to the Justice Department in June 2021 advocates said the plan was based on a “faulty assumption” that legal aid was plentiful in Boston and the other chosen cities — a critique that advocates echo to this day. “Legal aid nonprofits that provide no-fee representation are extremely overwhelmed,” Annelise Araujo, a Boston immigration attorney, said this week. “They are inundated with requests and they don’t have the funding or manpower to take them all on.” On a recent visit inside a courtroom, a clerk handed two families from Brazil packets of paper, including a few pages listing, in English, nine legal aid nonprofits. “This is a list of attorneys that can help you for little or no money,” Judge Michelle C. Kahan told the families through an interpreter. But if the families called the groups, they would find that Kahan’s advice was perhaps too optimistic. When a reporter called the nine listed phone numbers, six led to recorded messages saying the groups were “not accepting new cases at this time” or “have very limited capacity to accept new clients.” The Harvard report found that migrants who did not have legal representation fared significantly worse than those who did. During the first year of the Dedicated Docket, a mere 205 applications for asylum were approved. All had a lawyer, the report found. By contrast, 77 percent of migrants ordered deported in absentia did not have lawyers. Attorney Enrique Mesa said the Dedicated Docket seems, in some ways, to be self-defeating. The speed does little, he said, to decrease the overall workload. And the inevitable appeals end up proceeding on the courts’ regular timeline, often taking three to five years to reach a conclusion. One exchange he had with a Department of Homeland Security prosecutor seemed emblematic to him, Mesa said. A judge had granted his client’s asylum claim, seemingly bringing to a speedy conclusion a case that could have been long and complicated. But then the prosecutor appealed the judge’s decision, Mesa recalled, setting up what is likely to be a years-long legal fight. “That’s what really irks me,” Mesa said. “On one side you’re trying to get rid of these cases ASAP. But on the other side, it’s, ‘not so fast.’ How does this make any sense?” - See the full Boston Globe article.
Study: Stop Mandatory Child Abuse Reporting for Infants Exposed to Addiction Medications Massachusetts law says health care providers must contact child protective services any time a newborn has been exposed to opioids, including in-utero exposure to prescription medication used to treat an addiction to opioids. That can punish women in recovery, compelling some to stop treatment, according to a study out of Massachusetts General Hospital. The researchers have joined a growing list of child welfare experts calling for a change to the mandate. “It’s time for Massachusetts to stop stigmatizing women with a substance use disorder,” said the study’s senior author, Dr. Davida Schiff. “People are avoiding care because of the risk of mandated reporting.” The mandate is based on a section of the federal Child Abuse Prevention and Treatment Act. It requires notice to child protective services for infants “born with and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure” and tracking of those children. Massachusetts, unlike most other New England states, has interpreted that language to include two medications used to treat an addiction to opioids, buprenorphine and methadone, because babies may be born dependent on these drugs and need special care during withdrawal. Other prescribed drugs, such as medications for depression or diabetes, can also cause dependence at birth but are not typically reported, according to the study. The state Office of the Child Advocate recommended changes to the drug dependence reporting mandate in a report published two years ago. The result is pending legislation on Beacon Hill that would end automatic reporting of infants born dependent on an addictive substance. Instead, health care workers would assess the birthing parent. If a clinician is concerned that ongoing drug or alcohol use could put the infant at risk, those cases would be reported to the Department of Children & Families (DCF) and child protective services. If the parent is considered fit to care for the infant, then information about the birth would be reported to the Department of Public Health. All such cases would be reviewed periodically. State child welfare officials said in an email that they support this change. They said they already work with the health department on plans to support families and children dealing with addiction. Allen-Scannell said no one can guarantee that abuse or neglect won’t occur among children that would no longer be automatically referred to DCF, but the periodic reviews of cases not reported would help the state evaluate the change and adjust if needed. The House and Senate bills, like so many on Beacon Hill, are still in a committee. It's unclear whether lawmakers will take them up this session. - See the full WBUR story.
Minimizing the Risk of Scams for People Living with Dementia Financial crime against older Americans is a growing problem. People living with dementia are at an especially high risk of becoming victims of fraud and financial abuse. That’s why we’re grateful for Social Security’s unwavering commitment to combatting fraud. As their memory and other thinking skills decline, people with dementia may struggle to make financial decisions. They may not remember or report the abuse – or understand that someone is taking advantage of them. This abuse can occur anywhere – including at home or in care settings. Victims of fraud who are 80 years and older lose an average of $39,200 every year. Studies show that financial exploitation is the most common form of elder abuse. However, only a small fraction of these incidents are reported. You can help protect others by learning to recognize common signs of financial exploitation and abuse, including:
There are also many simple things that caregivers can do to reduce the risk of financial abuse and fraud for people with dementia and similar conditions, like Alzheimer’s. Do your best to make sure they’re involved in deciding which safety measures to put into place. Some options include:
To learn more, please visit our website or call the Alzheimer’s Association’s 24/7 Helpline at 800-272-3900. - From the SSA blog.
Human Trafficking Victims Getting Help with Visas Massachusetts law enforcement officials are increasingly helping victims of labor and sexual trafficking apply for a special immigrant visas, which advocates say is crucial to finding housing, work and getting their lives back. In 2022, there were 515 requests to police and state prosecutors from trafficking victims seeking legal protection under visa program designated for immigrant survivors of human trafficking, according to data from the state Executive Office of Public Safety and Security. Of those requests, 395 were approved, the data shows. That’s a more than 400 percent increase over the previous year, when law enforcement agencies received only 108 requests for nonimmigrant status certifications; approving 99 of them and denying 12 requests, according to the data. Glen Johnson, a spokesman for Essex County District Attorney Paul Tucker, said the DA’s office views the visa program an “effective tool to promote victim and witness assistance with our prosecutions of serious crimes such as domestic violence and involuntary servitude.” A 2021 state law requires law enforcement agencies to report the number of certifications they process. The data doesn’t provide details about individual cases, or explain the reasons under which applications were denied. It also doesn’t track visa approvals. Advocates say the visa program has become a lifeline for individuals who have suffered sex or labor trafficking. “It helps them to get benefits, find employment, go to school,” said Cherie Jimenez, who runs the survivor-led EVA Center in Boston, which provides emergency housing, food and other support for trafficking victims. “They need lawful immigration status to access programs and other services.” To be sure, certification for non-immigrant status by law-enforcement doesn’t necessarily qualify them for a visa. That is ultimately determined by the U.S. Citizenship and Immigration Services, which oversees the T visa program. Unlike asylum claims and other types of non-immigrant visas, most T-visa applicants can’t legally work until their application is approved, a process advocates say can take years. While the federal government allows up to 5,000 T-visas every year, only about 2,000 are issued annually, according to immigration data. A recent report by Boston University’s School of Law’s Immigrants’ Rights and Human Trafficking Program found that the program is also underutilized, with many victims unaware of the protections. “Denial rates have also ballooned in recent years, increasing to 42 percent in fiscal year 2020,” the report’s authors wrote. “These trends raise important concerns about whether immigrant survivors, especially those most vulnerable, can effectively access this important protection.” - See the full Eagle Tribune article.
With No State Oversight, Mass. Medical School Morgues are Vulnerable to Black Market for Bodies Medical school morgues — like the one at Harvard where a manager is accused of stealing and selling body parts for tens of thousands of dollars — face no state oversight in Massachusetts, state officials said this month. So-called “anatomical gift programs” at Harvard, Tufts, UMass and other medical schools, take private donations of whole bodies for medical research, including for the training of student doctors. But it appears no greater authority outside the schools monitors their procedures for keeping bodies secure. As Harvard and its donor families grappled with the shocking news, critics called for greater oversight. “Just like you wouldn't leave opioids in an unlocked drawer in a pharmacy, you need to protect the bodies of our loved ones,” said Patti Muldoon, president of the Funeral Consumers Alliance of Eastern Massachusetts. She said the state should be doing more to deter body thefts and to track cadavers, from medical donation programs to ultimate cremation or burials. The Harvard case laid bare a grim reality: there’s a black market for human remains. “We must understand the economics of the situation,” Muldoon said. “There must be oversight to counter the income one can make from selling off body parts." Speaking on WBUR’s Radio Boston Thursday, Gov. Maura Healey said the state currently has no oversight of medical school morgues. “We’ll take a look at it, obviously,” she said. Healey said the state does not plan to conduct its own investigation, but instead will let the federal cases play out. Neither the state Department of Public Health nor the medical examiner’s office has any responsibility for the medical school morgues, spokespeople for those departments said. DPH does have oversight authority over hospital morgues — just not those at medical schools. There appears to be no national oversight of medical school practices with dead bodies. The Association of American Medical Colleges said it has no role in medical schools’ body donations or how they manage their morgues. The American Association for Anatomy, in a statement , called for reforms to prevent something like the Harvard thefts from happening again. Though it’s a crime to obtain body parts through theft or fraud, the purchase and sale of human remains is largely legal in the United States. Native American remains are protected under the Native American Graves and Repatriation Act, and a few states like Tennessee and Louisiana restrict how human remains are imported and exported. Harvard said it’s conducting its own investigation into what happened at its morgue and has appointed an “outside panel of experts” to evaluate the program and morgue policies and practices. Harvard Medical School has declined to comment beyond a statement from the dean, calling the alleged crime a "betrayal." Representatives from other medical schools in the area, including Tufts, UMass and Boston University, declined to speak even generally about how their anatomical gift donation programs worked. Under state law, anyone over 18 can donate their body for research, with an emphasis on "donation" — it’s illegal to pay for a body. Before dying, people sign up with the individual medical school to which they wish to give their body. After death, the person responsible for making arrangements usually calls the school, who will say whether its program can accept the body. After the body has served its research purpose, families have options, according to Harvard's website. They can reclaim the person's remains or have the school perform a cremation. The cremated remains can be returned to the family or they can be buried at Pine Hill Cemetery in Tewksbury. Harvard holds a memorial service each fall for those who have donated their bodies. Other medical schools have similar practices. Muldoon, the Funeral Consumers Alliance president, said people may be less inclined to donate their bodies in the wake of the Harvard scandal, unless there is more state oversight of what happens to bodies after the research is complete. (Muldoon said her sister donated her body to a medical school.) - See the full WBUR story.
Judges Rebuke Social Security for Errors as Disability Denials Stack Up Thousands of disabled Americans battle for years for benefits, even after federal courts rule in their favor. In the last two fiscal years, federal judges considering appeals for denied benefits found fault with almost 6 in every 10 cases and sent them back to administrative law judges at Social Security for new hearings — the highest rate of rejections in years, agency statistics show. Court remands are on pace to reach similar levels this year. Federal judges have complained of legal errors, inaccurate assessments of whether claimants can work, failures to consider medical evidence and factual mistakes, according to court rulings and Social Security’s own data. The scathing opinions have come from district and appellate court judges across the political spectrum, from conservatives appointed by President Ronald Reagan to liberal appointees of President Barack Obama. Approval rates for benefits are down at every level of review, Social Security data show, even as the number of disabled people applying dwindled during the coronavirus pandemic. Fewer than 20 percent of those who lose their appeal at Social Security take their claim to federal court, as most lack the time or resources to keep fighting. The high rate of rejections for cases handled by administrative law judges and the attorneys who write their decisions is driven by stringent monthly quotas set by Social Security officials and growing pressure to deny more cases, according to current and former officials, audits and attorneys who represent the disabled. The agency’s policies have been reshaped to give less deference to the expertise of doctors who, in some cases, have treated claimants for years, and its policies routinely depart from federal appellate court rulings. The result has been an unmistakable shift to an adversarial disability system, advocates for the disabled claim: Rather than calling the case down the middle, they say, Social Security has stacked the cards against the approximately 2 million people each year who apply for help when they can no longer work. Yet federal judges rarely order the agency to approve claims in deference to the government, but instead must typically refer the cases back to the administrative law judges — often the very ones responsible for the errors in the first place, a common practice in administrative law that avoids asking a new judge to rehear a complicated claim. Only about half of the agency judges assigned to rehear cases they initially denied reverse those rulings, prolonging the cycle of appeals and new remands for disabled claimants, few of whom have means to support themselves, a Washington Post analysis found. Yet the rate of cases remanded to the agency from federal judges has long been a source of alarm inside Social Security, current and former officials said. For the last decade, roughly half of all cases that made it to federal courts have been sent back. Under a law known as the Equal Access to Justice Act, the government paid attorneys of claimants who prevailed in federal court $68 million in fiscal 2022, more than triple the sum a decade ago, data from the Administrative Conference of the United States shows. Social Security spokesman Mark Hinkle in an email defended the system, noting that disability decisions appealed to federal court “constitute a very small fraction of the overall decisions issued by the agency.” The disability system has relied since the 1950s on administrative law judges, who were meant to serve as impartial fact-finders in disputes over decisions on claims for benefits. These judges adjudicate disputes in government programs, operating outside the federal judiciary as they work directly for more than two dozen agencies. Their trial-like hearings are supposed to be free from agency coercion or influence. Administrative law judges must hear and make complex decisions in disability cases in less than three hours on average, Ramrup said. The role is complicated by the relatively subjective rules used to award benefits. While the judges ultimately answer to Social Security and do not enjoy the independence of the federal judiciary, they have chafed for years at a system that subjects them to scrutiny over how many claims they approve. Approval rates plummeted to 45 percent for several years, rising to 51 percent last year, agency data shows. Some administrative law judges who approved high numbers of cases found themselves under new scrutiny, a practice that accelerated during the Trump administration as political appointees took a hard line against paying claims, current and former judges and other officials said. Social Security officials declined to comment on specific judges or how widespread these reviews are today. The agency “monitors performance to ensure that decisions are consistent with [Social Security] policy, including regulations and rulings,” Hinkle wrote. “We provide feedback to [administrative law judges] regarding the quality of their decisions.” More than a decade ago, Social Security also imposed production quotas on judges to help address a historic backlog of appeals prompted by the Great Recession and a wave of baby boomers applying for benefits. But even after the logjam cleared, management continued to demand that judges hear and decide about 50 cases a month, Ramrup said. The bottleneck shifted to initial claims during the coronavirus pandemic, leaving fewer cases in the pipeline of appeals. Given these caseloads, administrative law judges rely heavily on mid-level attorneys to draft their decisions. Known as decision writers, they face production quotas, too. It’s a high-turnover job that requires years to become proficient. Training suffered during the pandemic, said Spencer Bishins, who left in 2021 after a decade as a decision writer, then wrote a book about why it is so hard to win disability benefits. “I’ve read a lot of very bad decisions,” Bishins recalled, “because the agency squeezes the [decision writers] so much.” “The decisions are getting worse with fewer cases,” he added. “Shouldn’t they be getting better?” While administrative law judges once based much of their decision on evidence from primary care doctors or psychiatrists who best understood their patients’ medical issues, that policy changed in 2017. Now judges are free to disregard the opinions of these treating physicians and rely heavily instead on contracted doctors who examine claimants for as little as 15 minutes, according to claimants, their attorneys and former Social Security employees. This often leads to shoddy records and poor decisions, federal courts have found. In recent years, other agency rules have also made it harder on applicants to prove their cases. Evidence can be excluded if a claimant submits it too close to a hearing. If someone applying for benefits cannot communicate in English, that language barrier is no longer a factor considered in awarding benefits under a rule change enacted in 2020. The Supreme Court has allowed vocational experts to refuse to disclose how they come up with jobs a claimant could still do or how many exist in the economy. An internal panel that Advocates say change is needed at every level of review to shift a culture that encourages Social Security judges to deny claims at the expense of the law. “Claims must be properly reviewed at the initial application,” said George Piemonte, a disability attorney in Charlotte who represents Rogers. “This can be a matter of life or death for a huge proportion of disabled people. Social Security needs to focus its efforts on getting things right in the first instance.” For many claimants, it’s easier to walk away than to keep battling. - See the full Washington Post story.
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