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MGH Community News |
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MGH Community News |
| July 2023 | Volume 27 • Issue 7 |
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. |
Clarification of End to RAFT Stipend Reported Last Month Last month’s article reporting the end of RAFT rental stipends caused some confusion. “Stipends” has a specific meaning in the RAFT context, referring to payment of future rent that could be requested if funds are available after arrears/overdue rent has been repaid. Reminder that RAFT can be used for a variety of purposes. For the first half of 2023 these included:
Eligible applicants can still access RAFT for some costs that have not yet been incurred, such as start-up costs (first, last and security deposit) and moving costs, but they can no longer request a month of future rent in current lodging. |
New MassHealth “Complex Care Assistant” Program Will Allow Legally Responsible Relatives (and Others) to Get Paid for Care to Eligible Members MassHealth is launching a new service type for complex care members who are authorized to receive Continuous Skilled Nursing services. Continuous Skilled Nursing (CSN) services is defined as requiring in-home nursing services for more than two continuous hours a day. The new service is called Complex Care Assistant services and it will be provided through MassHealth enrolled CSN agencies. Agencies are estimated to be able to start supporting this option in August/September 2023. Complex Care Assistant overview: What are complex care assistant services? What can a complex care assistant do? These services include:
When will complex care assistant services become available? Who can have complex care assistant services? Who can provide complex care assistant services? What is the difference between a complex care assistant, a home health aide, and a personal care attendant (PCA)?
What do I have to do to become a complex care assistant? More Information
CARES: New MassHealth Care Coordination Program for Medically Complex Kids MassHealth will soon cover a new targeted case management (TCM) service, the MassHealth Coordinating Aligned, Relationship-centered, Enhanced Support (CARES) for Kids Program enrolled in MassHealth Standard or MassHealth CommonHealth. The regulations are effective July 7, 2023, but provider organizations will need lead time to create their programs. The MassHealth provider types that may participate in the CARES program are:
Member Eligibility MassHealth eligible children and youth under the age of 21, residing in the community or home-based settings, who is a child with special health needs who requires ongoing medical management by at least two pediatric subspecialists, one of which must be for a medical condition that results in both of the following:
AND, in addition to the criteria above, must meet ONE of these conditions - EITHER A or B:
See the regulations for more details: Regulations- Transmittal Letter AOH-55 7/7/23 https://www.mass.gov/doc/aoh-55-revised-regulations-at-130-cmr-410000-0/download. For clinical eligibility criteria scroll to 410.482: CARES Program Services, section (C) Clinical Eligibility Criteria. CARES Scope of Services The CARES team will assist the member and their patient/guardian with the following Care Coordination and Family Support Activities by
Transition to Adulthood The CARES team must provide intensive support for member transitions into adult care, beginning once the member reaches 16 years of age, which includes, but is not limited to:
Conditions of Payment MassHealth will make a single per-member-per-month (PMPM) payment for CARES services rendered by a CARES services provider to a CARES services eligible member. To qualify for the PMPM CARES services payment rate in any given month, the CARES services provider must provide at least two of the CARES program services to a CARES services eligible member during that calendar month. Not more than one provider may be paid for CARES services per member per month. Further, MassHealth will not pay for more than one TCM service per member for the same dates of service, whether that TCM service is through the CARES program or a different MassHealth TCM covered service. Sources and for more information:
First Six Months of the State’s Mental Health Overhaul Reveal Promise and Challenges The state’s new “front door” to mental health care is six months old. The help line — 833-773-BHHL — is a key aspect of a broader overhaul of mental health services in Massachusetts launched on Jan. 1 by the Department of Health and Human Services. Providers and advocates say the overall project — which includes urgent care centers, short-term “crisis stabilization” beds, and a team-based approach to ongoing care — is showing promise but remains very much a work in progress amid severe staffing challenges. The help line, in the eyes of many, is a bright spot — “beautifully managed,” as one advocate put it. When Lynn, a Methuen mother called recently, a woman answered immediately and spoke in a voice Lynn described as soothing and kind. The help line is intended for anyone seeking mental health care, whether they are facing a crisis like Lynn’s daughter or just looking for help. Lynn, who asked to be identified by her middle name to protect her daughter’s privacy, explained the situation to the trained specialist on the phone. The woman connected her with the local mobile crisis team; such teams, which can include nurses, social workers, and other types of mental health providers, are situated around the state to visit people who need immediate attention, assess their condition, and guide them in the next steps. In the past, the crisis team was available only to people covered by MassHealth, the state’s Medicaid program, and Lynn has commercial insurance. But now, she learned that the state’s “Roadmap for Behavioral Health Care Reform” had made mobile crisis teams available to everyone. Unfortunately, on this night, the local crisis team was not especially mobile. They did not have enough staff to visit her daughter at home. It’s not clear how often this happens, but finding enough workers remains a challenge throughout health care, including behavioral health. Providing an alternative to ER visits is one of the key goals of the Roadmap for Behavioral Health Care Reform. Today, in emergency rooms throughout the state, hundreds of patients in crisis — many of them children — “board” for weeks or days awaiting a psychiatric bed. Emily Bailey, chief of behavioral health at MassHealth, said the state has seen a decline in ER boarding among MassHealth members since the beginning of the year. But data from the Massachusetts Health & Hospital Association show little change in the number of hospital boarders, with 548 in the week ending July 17, about the same as a year ago. The Roadmap involves much more than the help line and crisis teams. The state has contracted with providers who formed 25 new Community Behavioral Health Centers — CBHCs — to provide an array of services, including urgent care centers where patients can walk in, receive an assessment, and walk out with a connection to someone who will help. Instead of being paid for each encounter with a licensed clinician, the centers receive a flat fee per day for each patient. That frees them to employ workers whose services aren’t normally reimbursed: trained “peer specialists” who have personal experience with mental illness or addiction, and care coordinators who will help patients navigate the system. It also makes it easier to work in teams focused on providing whatever the patient needs, even if it’s not a medical service, such as help finding a place to live. The centers received 90,000 visits in their first three months of this year, while mobile crisis teams provided 13,000 visits on-site and in schools, homes, and group living environments, about 20 percent more than the previous year. The centers are currently serving primarily MassHealth patients, one-third of the state’s population. But if commercial insurers were to contract with these centers, their services would be available to privately insured people as well. So far, few have. State officials say a major goal in the coming months is to persuade more private insurers to sign on. Meanwhile, people with private insurance like Lynn continue to get care as in the past, through outpatient providers, which often involves long waits. Lynn said her daughter was seeing her regular therapist and seemed to have stabilized after a medication change. Even within the CBHC system, people may have to wait for treatment, especially if they want individual therapy, rather than group therapy or meeting with peer specialists. Under the Roadmap, MassHealth is paying higher rates to the centers than it pays for mental health services in other parts of the system. That has enabled Jeffers to increase salaries by more than 25 percent, which helped with both retention and recruitment in the CBHCs. But some said the higher salaries have meant that centers are cannibalizing the rest of the mental health system by drawing providers away from other programs. State officials said MassHealth is planning rate increases for certain services starting in August, to try to address this problem. Assessing the Roadmap rollout so far, Danna Mauch, president and chief executive of the Massachusetts Association for Mental Health, said, “Given the fact that this was implemented in the context of a workforce crisis, it is going better than many of us predicted.” Jeffers agreed. “It’s actually really impressive to see what has been accomplished by both the state and the providers,” she said. But she noted the demand continues to outstrip the supply of providers. “Everyone wants it to be at its full potential now. The reality is we still have work to do.” - See the full Boston Globe article.
Long a Sore Spot for Riders with Disabilities, Service on the RIDE has Gotten Worse Because of Staffing Shortages The RIDE provides transit service for Boston-area residents with disabilities who may be unable to use fixed-route service, such as buses and subways. Long a sore spot, service has gotten worse for some users as the acute labor shortage that has hit so many parts of the economy has left the RIDE well short of drivers and staffers for its call center. There is no app or real-time GPS tracking; the limited call and text alerts are unreliable. Seasoned RIDE users have become chary of taking the “arriving shortly” messages at face value. If their car doesn’t show, commuters have to call a hot line and wait on average more than five minutes for a dispatcher to provide an update. Meanwhile, drivers only have to wait five minutes before they can request to leave. If for some reason riders miss their pickup, no matter how long they’ve waited, they risk being labeled a no-show. Earn enough no-shows and they could get temporarily suspended from the service. Current MBTA paratransit ridership trails pre-pandemic levels, down to 111,000 in January from 157,000 in January 2020. Those figures mostly consist of traditional RIDE pickups, scheduled in advance and typically fulfilled by MBTA-branded vehicles, but they also count “on-demand” pickups, which are fulfilled by ride-hailing companies, including Uber and Lyft, and have grown to include about a third of all ridership. But even with fewer trips, the RIDE’s on-time performance has worsened since 2020: now at around 90 percent, from 95 percent of trips, bottoming out at less than 88 percent in April. And complaints continue to pour in as consistently as ever, according to data provided by the MBTA. It can be just as frustrating when a car shows up earlier than planned. In 2023, around 10 percent of pickups — such as Wice’s — arrived more than 15 minutes earlier than scheduled. While the RIDE does not require users to board an early pickup right away, many say they still feel compelled to hustle when the vehicle is sitting outside. In January 2020, fewer than 1 percent of pickups were delayed by more than 30 minutes. This year, it’s been between 2 and 3 percent, and each month, thousands of riders wait on the curb for at least 45 minutes. In periods of extreme cold or heat, riders say, that can feel like forever. The T’s chief of paratransit services, Michele Stiehler, said the decline in on-time arrivals stems from an industrywide worker shortage, which is creating a domino effect throughout the RIDE’s operation. Stiehler said the service had 21 percent fewer drivers than are needed, and its call and dispatching center, called The Ride Access Center, or TRAC, is also “close to 20 percent understaffed.” Multiple drivers told a Globe reporter the RIDE’s hiring issues stem from poor pay, and that wages don’t match the importance and difficulty of their work. One RIDE driver, interviewed while dropping off a passenger by Government Center Station, noted that MBTA bus operators make more for what he called an easier job. The starting wage for RIDE drivers ranges from just under $19 to around $20 per hour, Stiehler said. Meanwhile, regular T bus drivers start at $22.21 an hour, she said. Since the RIDE, which has a budget of about $130 million, outsources driving to several contractors, the MBTA does not directly control driver wages. But Stiehler said the agency is looking for ways to offset wages with what she called “market equity adjustments.” She said the RIDE aims to become “more competitive with the MBTA drivers,” but said a specific wage goal has not been finalized. Most RIDE trips are handled by two contractors: Veterans Transportation Services and National Express Transit. Representatives of National Express did not respond to multiple requests for comment. Kevin MacDonald, general manager of Veterans Transportation, referred questions about the RIDE’s operation to the MBTA, but wrote in an email that paratransit “has some of the most complex logistics found in any form of travel,” and Boston’s epic traffic only makes routing more difficult. - See the full Boston Globe article.
Family Shelters in Mass. Reach New Record Occupancy The commonwealth's family shelter system has reached an all-time high: 4,939 families with children living in state-run accommodations because they lack stable housing. As of July 24, most of them — 3,534 families — were in shelters around Massachusetts, while another 1,405 families were in overflow hotels and motels. State officials said they are working to expand capacity in the system — officially called Emergency Assistance — which is bulging at the seams. “Massachusetts faces an unprecedented increase in the number of families experiencing homelessness driven by high housing costs and new arrivals to the state,” said Kevin Connor, a spokesman for the Executive Office of Housing and Livable Communities, in a statement. He added that his agency, which oversees the family shelter system, is engaged in a “whole-of-government approach” to meet the needs of families. The last time emergency family shelters were serving this many people was in October 2014. The average family now spends a little over a year in state-funded shelter. Homeless advocates believe the number of families in the shelter system is just a fraction of the state’s total family homelessness. Some families do not qualify for state shelter, and some may be staying with friends or relatives which means they are not included in the shelter numbers. School data, which uses a broader definition of homelessness, suggests there are twice as many children experiencing homelessness as are found in state shelters. Kelly Turley, associate director for the Massachusetts Coalition for the Homeless, said even the school data is likely an undercount. “For every school-aged [homeless] child, it's estimated that there is another preschool aged child experiencing homelessness,” Turley said. “So the families that are in Emergency Assistance shelter really are just a small portion of all of the families, and all of the people in Massachusetts, who are experiencing homelessness.” Under a 1983 law, Massachusetts is required to provide shelter to eligible families, and the state has been lauded for creating one of the most comprehensive systems in the country. Some places, like New York City and Washington, D.C., have “right-to-shelter” measures, but Massachusetts is the only state with such a law. Last year, lawmakers allocated $264 million toward the emergency family shelter system. This year, lawmakers are considering earmarking just under $325 million. Some of the proposed funding may go toward a recent settlement in a class-action lawsuit that is prompting key elements of the shelter system to be revamped. What's driving the increaseAdvocates said there are several reasons for the recent increase in family homelessness in Massachusetts. In addition to an expensive housing market and swelling immigration numbers, some experts pointed to the end of pandemic-era programs such as eviction protection and certain federal funds to prevent homelessness. Rethinking family shelterThe state has started several new initiatives to address the growth in family homelessness, particularly the increase in newly arrived families. In June, the state opened its first Family Welcome Center and began offering some pre-shelter housing at Joint Base Cape Cod. It also launched a host family program. This month it began providing legal services to new arrivals, partly in an effort to expedite work authorizations. The record number of families in state shelters is prompting some advocates to call for a reevaluation of the state’s approach to family homelessness. “We're still having families go through this sort of traumatic shelter system,” said Aura Obando, medical director of Boston Health Care for the Homeless Program’s family team. For individuals, she pointed to the use of alternative programs such as permanent housing with supports that help people find jobs and address other challenges that contribute to their lack of housing. Obando argues that similar programs would help families with children. “Innovative housing models have been implemented for the adult and youth [homeless] populations much more than [for homeless] families,” she said. The stakes, she added, are high. For children experiencing homelessness, short-term problems like behavioral issues and potty-training regression can arise, as well as potential long-term health problems. Obando pointed to evidence that stress during childhood, like the strain caused by homelessness, can make a person more likely to develop chronic health and mental health problems later in life, such as diabetes, heart disease, depression and substance use disorder. - See the full WBUR story.
Court Blocks Biden Administration’s New Restrictive Asylum Policy – But on Hold On July 25th a federal judge struck down a stringent new asylum policy that the Biden administration has called crucial to its efforts to curb illegal crossings along the U.S.-Mexico border. The ruling was a blow to the White House, which has seen unlawful entries plunge since the new policy was put in place in May. But the policy has been far from the only factor in the dramatic decline in crossings, and how the ruling will affect migration, if it stands, is uncertain. The judge, Jon S. Tigar of the U.S. District Court in Northern California, immediately stayed his decision for 14 days, leaving the asylum policy in place while the federal government appealed the decision. The appellate court could extend the stay while it considers the challenge. “The ruling is a victory, but each day the Biden administration prolongs the fight over its illegal ban, many people fleeing persecution and seeking safe harbor for their families are instead left in grave danger,” Katrina Eiland, deputy director of the Immigrants’ Rights Project of the American Civil Liberties Union, who argued the case for the plaintiffs, said in a statement. The Homeland Security secretary, Alejandro N. Mayorkas, said the administration strongly disagreed with the decision. With the policy still in place while the decision is appealed, he added, migrants who did not follow the current rule would face stiff consequences. New U.S. programs have enabled several hundred thousand people to legally enter this year for stays of at least two years, provided they have a financial sponsor or an active visa application to reunite with relatives. Asylum seekers already near the U.S.-Mexico border are instructed to use a U.S. government app to schedule an appointment to present themselves at land ports of entry. While the program has some glitches, and many people wait months for an open slot, the number of appointments available has steadily increased, to about 40,000 a month.. Judge Tigar was not swayed, however, by the administration’s new legal alternatives, or parole programs, saying that they were not “meaningful options” for many people seeking asylum. “The rule generally relies on the parole programs for Cuban, Haitian, Nicaraguan, Venezuelan and Ukrainian nationals,” he wrote. “These programs are country-specific and are not universally available, even to the covered populations.” The contested rule presumptively denies asylum to those who have entered the United States illegally. Migrants apprehended at the border face expedited removal, unless they can justify being exempt from the policy — often without time to secure a lawyer to help them. The odds of ultimately securing asylum are low, but asylum seekers can live in the United States while their cases are pending in the backlogged courts. “Once in the immigration court system, they are eligible for employment authorization,” Blas Nuñez-Neto, a senior official at the Homeland Security Department, said last week. “That means they have years to live in the U.S. and earn money and support families back home,” he said during a discussion hosted by the Migration Policy Institute. “All these factors are drawing people.” - See the full New York Times article.
Student Loan Forgiveness is on the Way for Qualified Long-Term Borrowers More than 804,000 federal student loan borrowers are in for a pleasant surprise. While the Supreme Court scuttled President Biden's efforts at widespread debt forgiveness, these borrowers are about to get an email from the U.S. Department of Education, notifying them that their debts will soon be automatically erased. The forgiveness is the result of a promise made last year by the Biden administration in response to years of complaints, lawsuits and an NPR investigation that found that many long-time borrowers who should have qualified for loan forgiveness under the rules of the government's income-driven repayment plans (IDR) hadn't received it because of mismanagement by the department and loan servicers. Borrowers, advocates and journalists have warned for years of these IDR failures. While IDR rules have long promised a borrower's loan balance will be forgiven after 20 years of payments, a March 2021 report by borrower advocates found that, at the time, 4.4 million borrowers had been repaying their loans for at least 20 years – but only 32 had had debts canceled under IDR. Why? One huge problem: These IDR plans, meant as a safety net for low-income borrowers, were difficult to enroll in. So loan servicing companies often put financially distressed borrowers into long-term forbearance instead, a process that the companies' call center workers could more easily navigate over the phone. Forbearance may offer a short-term reprieve from payments, but interest continues to accrue. In April 2022, an NPR investigation, built on unreleased Education Department documents, revealed yet more problems with the department's handling of these IDR plans, including that several loan servicing companies weren't actually tracking borrowers' progress toward forgiveness (which the department knew) and that payment histories were often damaged and incomplete after borrowers were transferred from one servicer to another, a common practice. In response, the Biden administration pledged last spring to conduct a one-time "account adjustment" for federal student loan borrowers, giving them retroactive credit towards loan forgiveness for months spent in long-term forbearance. Even borrowers who were never in an IDR plan are now receiving or soon will receive retroactive credit toward forgiveness, "regardless of whether payments were partial or late, the type of loan, or the repayment plan," according to the department's release. - See the full WGBH story.
Massachusetts Rolls Out Online Assistance Guide for Flood Victims The Massachusetts Emergency Management Agency has developed an online guide to help residents, businesses and communities facing damage from this months flooding to access information about available services and financial assistance. “The severe weather events we have seen this month have been devastating to some of our towns, businesses, and families – especially in rural areas where hardworking farmers have lost acres of crops due to flooding,” Gov. Healey said in a written statement. “Our administration is deeply concerned for everyone affected by the floods and want to be sure they can access the help they need during this time.” - See the full MassLive article.
Outer Cape Towns Little Served with Public Dial-A-Ride Service, Data Shows The dial-a-ride, or DART, service offered by the Cape Cod Regional Transit Authority is advertised as an affordable “door-to-door, ride by appointment” option for all residents and visitors across Cape Cod. All 15 towns. But newly analyzed transit authority data requested by the Times showed a sizable imbalance in which regions of the Cape are being served. There were 63,052 total dial-a-ride trips recorded between January and June of this year, according to the data. But only 2.5% of the total number of rides — or 1,574 rides — came from the Outer Cape. “DART really isn’t intended for extensively long trips,” said Chief Financial Officer for the Cape Cod Regional Transit Authority Henry Swiniarski. “You can imagine the costs of operating the DART, we’re running at a pretty large per-hour cost. The idea of taking one individual from the Outer Cape to Hyannis or Sandwich, that would be an extremely expensive thing.” Both Swiniarski and Cape Cod Regional Transit Authority Deputy Administrator Kathleen Jensen said no requests for dial-a-ride service coming from the Outer Cape were denied in the last six months, but acknowledged limitations in Outer Cape dial-a-ride services. The Outer Cape refers to the outermost towns such as Orleans, Eastham, Wellfleet, Truro and Provincetown, where a car ride to the middle part of the Cape, and to centralized medical offices and Cape Cod Hospital in Hyannis, could take 45-60 minutes. Of the 12,264 rides classified as a medical or dental appointment, only 145 came from the Outer Cape. “I know that the CCRTA provides DART ride services for all 15 towns,” Thomas said. “However, because they are limited to providing service where the most requests are, demographics don't lend themselves to showing a justification for more service.” Said Suzanne Grout Thomas, director of community services for the town of Wellfleet. Public agency says expense is the biggest concernSwiniarski said funding and budget restrictions are some primary limitations on Outer Cape dial-a-ride services . “We need to live within the constraints of our budget,” he said. “But we have our efforts to take our budgetary dollars that are available to us to see where we can, in an efficient way, provide additional transportation services.” Other alternatives to dial-a-ride for residents and visitors on the Outer Cape include FLEX bus routes and a Peter Pan motor coach line. The FLEX bus, also part of the transit authority, deviates, or flexes, off its route up to three-quarters of a mile to serve people who may have trouble getting to a designated bus stop. FLEX routes include a Harwich to Provincetown line and vice versa, according to the transit authority’s riders guide for the summer. These routes run seven days a week and begin service between 4 a.m. and 5:30 a.m. depending on the day — FLEX routes end between 9:30 p.m. and 9:50 p.m., according to the guide. After riders get off at the Harwich stop — if they are taking the FLEX from Provincetown — they would then take the H20 bus, another transit authority bus, into Hyannis. The transit authority also began partnering with Peter Pan bus service in 2019, providing bus rides from Provincetown to the Hyannis Transportation Center three times a day — 8:45 a.m., 1:35 p.m., and 6:45 p.m. The transit authority partnered with Peter Pan "to make sure that people in the Outer Cape area are able to get a more express run to some other health care facilities and hospitals,” Jensen said. Budgetary concerns could soon changeState Sen. Susan Moran, D-Falmouth, recently filed a bill that aims to increase regional transit accessibility in the state. She said the bill introduces an additional $100 million for regional transit funding and grants, bringing the total Senate budget to $194 million for regional transit authority funding — a figure that is double from last year. If you build it they will come,” Moran said of bolstering public transportation infrastructure. “If we provide funding for more frequency and availability of rides, then the ridership will realize the availability of the service.” - See the full Cape Cod Times article.
Former Becker College Dorms in Leicester to Serve as Shelter for 66 Families After sitting empty for nearly two years, three former Becker College dormitories in Leicester are being renovated to serve a new purpose as a family shelter. The town, the state’s Executive Office of Housing and Livable Communities and Central Massachusetts Housing Alliance are working together to redevelop the dorms into emergency housing that will provide shelter for 66 families, according to CMHA CEO Leah Bradley. The town of Leicester purchased the former Becker College campus for $18 million after its board voted to shut down the school for good in 2021, partially due to the impact the coronavirus pandemic had on the institution’s finances. When the town was approached by CMHA and the state’s housing office about using the dorms for family shelter, Genereux said, it seemed like a natural fit. The dorms are “really set up to fill that need,” Genereux said, and have limited use outside of it. The income will also help with the town budget. “It’s a gross annual income of $2 million per year for the rental agreement,” he said, adding it’s a really good benefit for the town. CMHA has been working with the state’s housing office to find additional sites to increase the state’s shelter capacity as the current shelters are full and the state has been using hotels and motels to meet the need. Massachusetts is a right-to-shelter state, meaning the state is obligated to provide families with a place to stay. The dormitories can be quickly transitioned into family shelter because of the way they’re set up, according to Bradley. What will the former Becker College dorms offer? The town is responsible for the renovations, which will include making sure families can cook on site, according to Bradley. The town is adding in stoves, refrigerators and other things to make sure families can provide their own meals. There will also be common spaces that the families will be able to enjoy, she said. Since the buildings are on a former college campus and current high school campus, there will be green space that the families can enjoy and Bradley said CMHA would love to add a playground in the near future. Transportation is often an issue for families experiencing homelessness and CMHA plans to reach out to the Worcester Regional Transit Authority to see if they will add a stop at the dorms. Otherwise, the closest WRTA site is about a quarter mile away from the dorms on Rte. 9 and families will be able to use the bus pretty easily to get to stores like Walmart, according to Bradley. CMHA has a team of people that will be working with the families to develop a rehousing plan to get them into housing as quickly as possible. Any families in the state could be assigned to the shelter at Becker College, but Bradley said CMHA works closely with the Executive Office of Housing and Livable Communities to make transfers when possible to get families closer to where they work and their medical care. - See the full Mass Live article.
New App Allows People with Disabilities to Report and Respond to Abuse A team at the University of Rhode Island has developed a new, free app that helps teach adults with intellectual and developmental disabilities how to recognize abuse and report it. R3: Recognize, Report and Respond is the brainchild of Krishna Venkatasubramanian, a computer science professor at the URI. It’s available through Apple and Amazon app stores for smartphones and tablets. Q: What is R3, and how does it work? When someone does report abuse, where does that report or claim go? How did you come up with this idea? How did your original idea change while you developed the R3 app? So we pivoted and said we needed to create an educational app before we really focused on the reporting tool [which is still in the pipeline]. How did you build an app that does use images, videos, and text to describe examples of abuse while also not further upsetting or re-traumatizing users? Some of the content is hard to watch, or sensitive for those who have had past experiences with abuse. But we have some barriers to help with this, including a checking system where the app will regularly ask the user how they’re feeling. Depending on their answer, the app will then suggest a new list of activities that are in there — including calling a “trusted person” that can be set up ahead of time. What’s next? - See the full Boston Globe article.
“How to Get On” Website – Self-Advocacy Guide for People with Disabilities In searching for the answer to a question about Section 8 housing posted on my AskHarry.info website, I came across a phenomenal site providing hands-on information about all aspects of living with a disability: How To Get On. It describes itself as a “self-advocacy guide for anyone who is homebound or bedbound” in the United States with the goal of assisting users in having a “great, disabled life.” How to Have a Great, Disabled Life Covers the Gamut The site’s special focus is on people who suffer from Myalgic Encephalomyelitis, more commonly known as Chronic Fatigue System (CSF), but is useful for anyone with a disability or who is assisting someone with a disability. Topics include:
This is only a partial list. In each topic, the site drills down to practical questions. For instance, in the SSI (Supplemental Security Income) section, the includes all the basic eligibility information, but also addresses:
With a Sense of Humor The site posts are written in clear English rather than legalese and with a sense of humor. One of its sections that I particularly like is its Sleepy Girl Video Festival which contains links videos created mostly by people suffering with Chronic Fatigue Syndrome. I love the one created by “Yulia” explaining CFS to the “perplexed friend or family member.” - From Margolis, Bloom & D’Agostino.
MLRI's New MassHealth Redeterminations Website! Mass Law Reform Institute (MLRI) has launched Masshealth Project.org, a website for consumers and advocates regarding the April 1, 2023 to March 31, 2024 MassHealth eligibility redetermination process. Shout out to our summer intern, Danielle Stewart, for making it happen! The website includes flyers to help consumers and advocates navigate aspects of the redetermination process links to helpful resources from MassHealth and the Health Connector and a calendar of redetermination-related events. More to come! We'll continue developing informational material and adding to the website- including FAQs for consumers and advocates. - From Next HCWG Meeting- Aug; MLRI redeterminations website, Kate Symmonds, MLRI, July 21, 2023.
Medicare Reminder: Medicare Coverage of Non-Emergency Ambulance Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by other means. If your trip is scheduled when your health is not in immediate danger, it is not considered an emergency. Part B covers EMERGENCY ambulance services if:
To be eligible for coverage of NON-EMERGENCY ambulance services, you must:
Medicare may cover unscheduled or irregular non-emergency trips, but if you live in a skilled nursing facility (SNF), a doctor’s written order may be required within 48 hours after the transport. Medicare never covers ambulette services. An ambulette is a wheelchair-accessible van that provides non-emergency transportation. Medicare also does not cover ambulance transportation just because you lack access to alternative transportation. Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($226 in 2023). All ambulance companies that contract with Medicare must be participating providers. Note that if you are receiving SNF care under Part A, most ambulance transportation should be paid for by the SNF. The SNF should not bill Medicare for this service. Note - some Medicare Advantage Plans may cover additional types of transportation as a supplemental benefit. - From Dear Marci: How does Medicare cover ambulance rides?, Medicare Rights Center, July 3, 2023 with additional material from Dear Marci: Will Medicare cover scheduled transportation?, Medicare Rights Center, July 17, 2023.
Medicare Reminder: Medicare and Dental Care Medicare does not cover dental services that you need primarily for the health of your teeth, including but not limited to:
Note: Some Medicare Advantage Plans cover routine dental services, such as checkups or cleanings. If you have a Medicare Advantage Plan, contact your plan to learn about dental services that may be covered. While Medicare does not pay for dental care needed primarily for the health of your teeth, it does offer very limited coverage for dental care needed to protect your general health, or for dental care needed in order for another Medicare-covered health service to be successful. For instance, Medicare may cover:
It is important to know that while Medicare may cover these initial dental services, Medicare will not pay for any follow-up dental care after the underlying health condition has been treated. For example, if you were in a car accident and needed a tooth extraction as part of surgery to repair a facial injury, Medicare may cover your tooth extraction—but it will not pay for any other dental care you may need later because you had the tooth removed. Medicare also covers some dental-related hospitalizations. For example, Medicare may cover:
In these cases, Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists. Further, while Medicare may cover inpatient hospital care in these cases, it never covers dental services specifically excluded from Original Medicare (like dentures), even if you are in the hospital. - From Medicare Watch: MSP Expansion in New York--New Report Highlights Lessons Learned and Other Needed Improvements, Medicare Rights Center, July 27, 2023.
Bill Would Make Kids Without Legal Immigration Status Eligible for MassHealth Lawmakers on the MA Health Care Financing Committee recently heard testimony on bills that would extend comprehensive MassHealth coverage to Massachusetts residents under age 21 who are currently ineligible only because of their immigration status. Children without legal immigration status are not eligible for full MassHealth coverage. Bill supporters said that leaves families to navigate a complicated patchwork of safety net programs that have limits on coverage for some services like mental health, dental care or prescription drugs, and do not cover others, like eyeglasses or home health care. Chelsea resident Ruth Gomez told the committee that she and her family came here from Honduras to seek a better life for her son Dylan, who was born without eyes, is mostly deaf, and has severe developmental disabilities and limited mobility. Speaking in Spanish with an interpreter, Gomez said the limited insurance Dylan initially had didn’t cover much of what he needed, including walking aids, hearing aids, behavioral therapies and tests recommended by doctors. When the family received a new immigration status this year and Dylan could get standard MassHealth, it “made a world of difference,” she said. “Before, feeding him used to be very stressful for me because I was was so fearful he would choke every time,” Gomez said, “Now, with the new health coverage, we have access to a treatment which helps him swallow with more ease, allowing Dylan to eat solid foods and have better nutrition.” The bill pending before the committee would direct state health officials to "maximize federal financial participation for the benefits" that would be extended to previously ineligible children, but says that the benefits shouldn't be conditioned on whether federal money is available. Amy Grunder of the Massachusetts Immigrant and Refugee Advocacy Coalition said many of new arrivals to the state are families with young children. She said some newly arriving immigrant children, such as Haitians and Venezuelans participating in an immigration parole process, are able to access comprehensive medical coverage, while others, including asylum seekers, cannot. An asylum claim can take months, assuming a pro bono lawyer is even available, Grunder said. “These children often need access to mental health services as well after undergoing the trauma of a harrowing journey of months or in some cases years to get here,” she said. Twelve other states already have similar laws on their books, according to Health Care for All, including Connecticut, Vermont, Rhode Island and Maine. - See the full WGBH story.
The Pandemic Brought New Rules for Assisted Living Facilities. Will Massachusetts Keep Them? The arrival of the COVID pandemic brought new rules for assisted living and other residential settings. With visitors restricted, an emergency order let assisted living nurses temporarily provide health services that tended to fall to friends and loved ones. That permission remains in place through March 2024. But just like takeout cocktails, remote municipal meetings and other policies adopted to solve pandemic-era problems, lawmakers will have to decide whether to keep the policy or let it lapse. One lawmaker who wants to make the change permanent is state Rep. Smitty Pignatelli, a Lenox Democrat. He first learned about the issue when his parents were considering assisted living. “I think it's foolish to tell a nurse who is certified to do those things that they can't do it in an assisted living center, but me, the state rep, could learn how to do it and inject my own father with the shots that he needed,” Pignatelli said. The Massachusetts Assisted Living Association backs the bill that Pignatelli filed alongside a pair of key lawmakers: Elder Affairs Committee chairs Rep. Thomas Stanley and Sen. Patricia Jehlen. That bill would change state law to permanently allow nurses in assisted living centers to provide a limited list of services, like injections, eye drops and oxygen management. Association president Brian Doherty said he’s seen positive results from the policy while it’s been in place. “Because the nurse is overseeing the overall care plan for that resident, it helps that they can give them an insulin injection at the optimal time and that improves their overall health outcome,” he said. Assisted living residences vs. nursing homesBut not all in the industry are aligned. The Massachusetts Senior Care Association, a group that represents a broad umbrella of long-term care organizations, including nursing homes and assisted living residences, has concerns with the bill, particularly around consumer protections and making sure costs for nurse-provided services are disclosed to residents. At an April hearing on the bill, elder law attorney Kathleen Lynch Moncata asked the Elder Affairs Committee to be cautious as they consider changes. She said that the 1994 Massachusetts law establishing assisted living residences did not envision them as medical facilities, and that they’re regulated by the Executive Office of Elder Affairs, rather than the Department of Public Health, which oversees nursing homes. “Permitting ALRs to provide basic health services is an appealing concept, but must be accompanied by corresponding, meaningful increased oversight, and looking at this bill, the language does not provide such oversight,” she said. Most people who testified on the bill spoke in support of it, including Smith, - See the full WGBH story.
Editorial – Does a Housing Application Really Need to be 30 Pages Long? Scroll through applications for affordable housing in Massachusetts and you’ll find some that require upward of 30 pages of personal information. Just to get on a waiting list, applicants might have to answer detailed questions about sources of income, household members, references, criminal record, asset transfers, and more. Subsidized housing exists to correct a long-term policy failure: For a century, the state has let cities and towns thwart construction, especially of apartments. But actually securing one of those subsidized units is a herculean task. In a system that lacks centralization and standardization, applicants are forced to collect and provide mounds of information — then do it again, and again, and again. And once submitted, applicants — and experts who help those seeking housing — say developers rarely get back to applicants so there is no way to know whether someone filled out the application properly or whether a document was missing. The cumbersome and confusing maze is excessively daunting to people whose lives are already difficult. And the overall inefficiency of the system makes it harder for subsidized housing to deliver on what should be a key goal: providing residential opportunities to people who have been denied them because of the state’s history of exclusive zoning. One solution worth considering, despite real implementation challenges, is the creation of a common, universal pre-application for subsidized housing. Either the state or a private entity would craft a short document where someone could enter the basic information needed to determine their eligibility for subsidized units — things like income, assets, family size, location, and accessibility needs. That document could be submitted to private- and public-housing projects to enter their lottery or join their waiting list. Anyone who actually obtains a unit would still have to provide all the necessary documentation — tax returns, pay stubs, background and credit check authorizations, etc. The Boston Foundation, in its 2022 Greater Boston Housing Report Card, recommends developing something similar to the Common App for college applications that would let seekers of subsidized homes use the same form to apply for multiple housing developments. This would reduce barriers for home-seekers, the report writes, and allow regulators to better scrutinize any additional information requested later to determine whether it creates inequitable burdens for prospective tenants. There are some models for a common application. The state already operates CHAMP, a common housing application for state-run public housing. But that does not cover federally administered public housing or subsidized housing that was built with tax credits and operated by private developers. New York City has a common application for multiple affordable housing lotteries. The City of Somerville is developing a consolidated waiting list, where people can use one application to apply for multiple buildings with lower-than-market-rate rent in Somerville. In 2019, Jennifer Gilbert launched Housing Navigator Massachusetts, a game-changing website that lists all subsidized housing units in Massachusetts with information about how to apply on an easily searchable site. The next step, Gilbert acknowledges, is to make applying easier. “There’s just not any kind of standard or recommended best practices for what you should ask,” Gilbert said. She said some developments have basic pre-applications, while others require 20-plus page applications, similar to applying for a mortgage, just to enter a lottery. Often by the time someone actually gets a unit, the information on their initial application is outdated. “The forms themselves are a huge barrier to housing access,” Gilbert said. Kimberly Goldstein, a clinical social worker at Boston Children’s Hospital, said she encourages families to fill out five applications a week until they find housing — what she describes as “an arbitrary number … that seemed not too onerous.” But she knows that is only possible for families that have the language skills, technology, time, and education to be able to fill out the applications — things many families she works with do not have. Judy Weber, an independent consultant who has worked on affordable housing issues, agreed that the application process “can be onerous, cumbersome and difficult,” resulting in applicants getting excluded from waiting lists because of minor application flaws. However, creating a universal application will not be easy. Different tax credit and subsidy programs have different requirements for eligibility and preference. For example, some housing developments are reserved for people with disabilities so asking someone about their disability status is necessary — but asking someone about their disability status for a non-reserved unit violates fair housing laws. Different programs use different calculations of income or assets, and these definitions would need to be standardized in a common application. Developments in different geographic areas have different income eligibilities. Any new application system would need to sync with whatever computer system large developers use to manage property vacancies. Creating a common pre-application would require extensive coordination between federal, state, and private housing developers and managers. The state — and newly appointed housing secretary Edward M. Augustus Jr. — are best positioned to take the lead. - See the full Boston Globe article.
Thousands of Mass. Residents Languish on Subsidized Housing Wait Lists Sitting in a long queue for subsidized housing in Massachusetts - it’s a familiar story of patience and purgatory for tens of thousands of people who languish for years on wait lists that have only gotten longer and longer still. Among the lesser-known aspects of Massachusetts’ acute housing crisis are the myriad wait lists low-income residents go on to become eligible for a subsidized home. There is not one, but rather dozens of different lists — each maintained by a local housing authority or nonprofit. There are also different types of aid people can apply for, such as vouchers for a market-rate apartment, a lottery for an affordable unit set aside in a new apartment building, or acceptance to a traditional public housing complex. Since the inception of wait lists in the past century, there has scarcely been a time when there were enough affordable units in Massachusetts to meet demand. And recent data shows the state is moving backward. In 2017, the average wait time across the lists was two years. By last year, it had doubled to four, according to a January report from the advocacy organization Housing Works. The longest lists stretch nearly two decades. Some particularly lengthy queues are closed to new applications altogether. Metro Housing Boston, the nonprofit agency that administers nearly half of the available Section 8 vouchers in the state, is currently distributing them to people who applied in 2009 — 14 years ago. Even elderly residents, given priority due to their age and medical complications, often must wait upward of one year, said Nina Lordi, a case manager at the Community Day Center in Waltham. Compare that to the 1990s, when it was common to wait only six months for an apartment. Housing authority directors and advocates all use the same few words to describe the wait list system: ineffectual, bureaucratic, broken. “A nightmare of epic proportions,” as one put it. They decry the lack of a centralized application among the agencies that manage vouchers and subsidized apartments, and the disorganization of the process. Some authorities only take applications in writing; others require an online process with a different portal and password and caseworker for each. Applicants can be rejected for something as minute as an unchecked box. Occasionally people remain on a wait list for years, only to learn that they are not eligible when they reach the front of the line, said Chris Norris, executive director of Metro Housing Boston. “People will put their names on as many as possible,” he said. “But it takes an expert to navigate the system we’ve created, because it’s so byzantine.” Beyond bureaucracy and bloat is a more fundamental problem. There are simply not enough affordable units for all the people who need them, and little turnover among people who have them. Applicants who claw their way into a low-cost apartment are unlikely to give it up anytime soon, and a well-documented shortage of housing at all price points simmers below it all. Without a centralized list, it’s hard to even know how many people are waiting for a subsidized unit. Disparate figures abound. The Boston Housing Authority counts more than 37,000 people on its wait list. Some 57,000 are on the statewide list for a Section 8 voucher. Metro Housing Boston gets about 1,300 new applications a month. - See the full Boston Globe article.
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