Highlights

• Fuel Assistance
• Impact of Possible Government Shutdown
• Benefits for LGBTQ+ Veterans
• Free COVID tests
• Info for Pregnant MassHealth Members
• Medicare Savings Programs Simplified

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

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

Massachusetts is funding an overdose prevention hotline, the first such investment by a state according to public health leaders.

The hotline, which has been privately funded until now, allows people using drugs alone to be monitored during a phone call, and receive emergency medical care if they overdose.

The Massachusetts Overdose Prevention Helpline (800-972-0590) is staffed by paid and volunteer workers, many of whom have experience with drug use. Staff answer calls 24 hours a day, seven days a week. The hotline provides people preparing to inject, swallow or snort drugs a toll-free number: 1-800-972-0590.

The helpline is run out of Boston Medical Center (BMC) and modeled on a nationwide program called  "Never Use Alone".

When a hotline staffer answers the phone, callers give an address and cellphone number. The staffer stays on the phone for at least five minutes — sometimes longer — after the caller uses drugs.

If the caller stops responding to questions, the staffer calls 911. A caller's address is only shared if there’s a suspected overdose.

So far this year, staff on the Massachusetts hotline have monitored nearly 600 injections or other types of drug use and called emergency medical services to assist with eight overdoses.

The state funding started in August. Organizers said they are expanding the program, which operates out of BMC’s Grayken Center for Addiction. RIZE Massachusetts Foundation provided the initial funding. The Massachusetts Harm Reduction Advisory Council helps train helpline volunteers.

Gov. Maura Healey announced the $350,000 contract during a Recovery Month celebration Tuesday. A DPH spokeswoman says the department is using this year to pilot the project and will determine a long-term approach after it reviews call data.

Some advocates are pushing for supervised consumption sites where people can use drugs under the supervision of trained staff, but so far none are available in Massachusetts. The hotline offers an alternative.

“The overdose prevention helpline is an important tool in our toolbox,” said Deirdre Calvert, director of the state Department of Public Health’s Bureau of Substance Addiction Services, in a statement. “If we want to turn the tide and decrease overdose deaths, we need to support bold innovative programs like the overdose prevention helpline.”

- See the full WBUR story.

Related: This American Life recently focused an hour-long episode on Never Use Alone, “The Call”.

The Home Energy Assistance program (LIHEAP), often called Fuel Assistance, online application opens on October 1 for the upcoming heating season (November 1, 2023 – April 30, 2024). You can submit an application online, in person at the LIHEAP agency in your area, or by mail. Use the LIHEAP portal to find your agency or start the application. Households must apply each year.

• First time applicants must participate in an intake appointment, to get started please submit an online application or contact your local agency.
• Applications are mailed to households after the first year and can be renewed online, in person, or by mail.

Eligibility

While income is not the only factor in eligibility, please find the maximum FY 2024 income guidelines in the table below and in this FY 2024 LIHEAP Income Eligibility and Benefit Chart (in the “60% of estimated state median income” column). Not all income counts toward eligibility, so please confirm your actual eligibility with your local agency.

Source and for More Information: Mass.gov - LIHEAP  

Lawmakers in Washington, D.C., have yet to agree to a spending plan ahead of the Sept. 30 end of the fiscal year, and inaction by then could trigger a government shutdown that would halt spending by many agencies and likely push government employees into furloughs without pay.

More than 24,500 federal employees are based in the commonwealth, according to the Congressional Research Service. Across New England, nearly 61,000 workers could be affected.

Healey’s office said in the event of a shutdown, there would not be an immediate impact for families on WIC in MA (contrary to some press accounts) because state funds would support the program for a brief time. SNAP benefits too would continue uninterrupted for the month of October only.

But if a shutdown were to drag on, that would be a different matter. Laura Fisher, executive director of Just Roots, a community farm in Greenfield, said the main impact “would be the terrifying prospect of SNAP drying up at the end of October.” SNAP is the Supplemental Nutrition Assistance Program, or monthly food assistance program that millions of low-income Americans depend on and that’s funded by the federal government

More than 1 million Massachusetts residents depend on SNAP benefits, according to an account of shutdown impacts compiled by U.S. Rep. Lori Trahan’s office.

Other Affected Areas

Medicare and Social Security: Payments through Medicare and Social Security will keep going out automatically regardless of a shutdown. Still, since some staff at those agencies may face furloughs, initial Medicare enrollment could be disrupted.

Cash Assistance from DTA (TAFDC, EAEDC): a shutdown would have no impact on Massachusetts’ DTA cash benefits or applications.

Housing: Advocates are bracing for the impact of a shutdown, which could affect recipients of subsidies including Section 8 Housing Choice vouchers, according to U.S. Department of Housing and Urban Development’s contingency plan.
Michael Kane, head of the Massachusetts Alliance of HUD Tenants, said advocates sense what’s to come because of previous shutdowns. Kane said when the government shut down in 2018, landlords continued to receive payments from the Boston Housing Authority, one of the largest administrators of federal vouchers in the state. But he said those funds could dry up if a shutdown goes on long enough.

Doug Quattrochi, the head of Mass Landlords, agreed it's a matter of wait-and-see for now. In prior shutdowns, he explained, funds for Section 8 had already been set aside, so there was enough funding to pay rents.

Health care: Medicare benefits won’t be affected, but administration and enrollment could face disruptions. U.S. Rep. Jake Auchincloss, a Newton Democrat, said, “Much of that work will grind to a halt and that could lead people in bad situations with their health care.”

Head Start: Some of the 159 programs in the Commonwealth run on a fiscal year calendar that begins Oct. 1. Tommy Sheridan, the deputy director of the National Head Start Association, says such centers would have to pull from reserves or lines of credit, and could temporarily close if the shutdown lasts long.Amy Kershaw, the state’s early education and care commissioner, told GBH News her department is in close contact with Head Start programs and that the state will provide affected programs with “advanced grant funding” in the case of a shutdown.

Veterans: VA benefits like health care and pensions also continue automatically. 

Disaster payments: Payments from the Federal Emergency Management Agency are expected to halt. This could have an impact on western Massachusetts farms and other locations impacted by this summer’s heavy rains and flooding.

Air Travel: When it comes to flying, officials at Massport said they expect interruptions in service. Air traffic controllers and security officers are considered essential and would have to continue to work, but would not be paid until after the shutdown ends. However, during previous shutdowns, many began calling out sick, leading to delays at airports. If you're traveling in the near future, plan accordingly.

- See the full WBUR story with additional information from What happens in Mass. if the gov shuts, WBUR Today, September 29, 2023.

More Information

• MLRI is keeping this MassLegalServices.org/2023Shutdown page updated with information about SNAP, WIC, and other public benefit programs. 
• DTA has posted FAQs about a federal government shutdown here, reassuring households that SNAP will go out normally in October.
• WIC has posted information reassuring families WIC will operate as normal, for now,on their Mass.gov page here.

As reported last month, Massachusetts K-12 public, nonprofit private and residential child care institutions are offering free meals to all students. But some parents might still see some charges. If a student gets extra items, such as an extra a slice of pizza after their first lunch, or other a-la-carte items, such as cookies or ice cream, they will be charged for it. If parents see a charge, they might want to discuss with their children.

MassLive had initially reported, in error, that students might be charged for their meal if they don’t take a fruit and a vegetable. It is true that if a student doesn’t take a fruit and a vegetable with their meal the school would not receive federal reimbursement for that meal. The Massachusetts Department of Elementary and Secondary Education (DESE) subsequently clarified, and MassLive updated, that if a student skips taking the fruit or vegetable that day, the school cannot charge the student. If parents see a charge for this, they are advised to contact the school.

- See the full MassLive article.

As reported last month, the new state budget extends the Massachusetts State Veterans’ Bonus to LGBTQ and HIV+ veterans who were dishonorably discharged "due to sexual orientation, gender identity, gender expression or HIV status." Gov Healey announced the process this month, officially dubbed the Veterans Equality Review Board, or VERB.

Who's eligible: Any veteran who believes they got an "other than honorable discharge" due to the since-repealed policy of "Don’t Ask, Don’t Tell," or their sexual orientation or gender identity.

You can apply online or through the snail mail here. Officials say applicants should hear back from the state in around one to two months.

FAQs  

The U.S. Department of Defense this month launched a new website to help people discharged under the policy request a correction to their military record.

- From WBUR Today, September 21, 2023 and https://www.wbur.org/news/2023/09/21/lgbtq-veterans-discharged-benefits

The MBTA has announced that travel on the Fairmount Commuter Rail Line will be free during the upcoming 16-day closure of the Red Line’s Ashmont Branch and Mattapan Line from October 14-29 in which train service will be replaced by shuttle buses. As previously announced, the MBTA is performing major track improvements across the Ashmont Branch and the Mattapan Line. Fairmount Line fall/winter schedules are available at mbta.com. The MBTA is also in the process of developing a tailored Riders’ Guide that includes alternate travel options and more, which will be available online soon.

“The upcoming work on the Ashmont Branch and Mattapan Line is critical to addressing and improving safety and reliability along this stretch of the Red Line, and the complete closure of these lines allows us to accomplish vital work in 16 days. While this service change will be challenging for our riders, they have let me know that they appreciate that we are committed to improving their travels,” said MBTA General Manager and CEO Phillip Eng. “By offering alternative shuttle bus service and now announcing free travel on the Fairmount Commuter Rail Line during the closure, we want our riders to know that we want them to continue to use mass transportation while we perform this work, and that we value and understand how they rely on the MBTA and the services we provide.”

The MBTA is also reminding riders of an upcoming public meeting regarding the closure: 

DATE: Saturday, September 30, 2023
TIME: 1 PM – 3 PM
LOCATION: Codman Square Health Center Great Hall, 637 Washington St, Boston, MA.

- From MBTA.com

Thirty states, including Massachusetts, are pausing the removal of thousands of people from Medicaid rolls for those impacted by a  “glitch” identified by the federal government that had mistakenly deprived half a million eligible people across the country of state-sponsored insurance.

State officials estimate the affected number in Mass is approximately 4,800. All impacted Massachusetts residents will regain coverage, according to the state.

States use an auto-renewal process to determine if people are eligible for Medicaid, using information available through state wage data and other sources. Federal officials say such a process makes it easier for people to renew their Medicaid insurance or remain on its sister program, the Children’s Health Insurance Program.

However, in a media briefing, the federal agency said it had noticed when looking at data and talking to states that the automatic renewal system was assessing eligibility at the family level rather than the individual level, even though individuals in a family might have different eligibility for the program. For example, children are likely to be eligible for Medicaid or CHIP even if their parents no longer qualify.

“The most important piece is every single one of those states is required to pause procedural disenrollments for anyone impacted by this glitch, to reinstate people until they can regain coverage, and continue pausing procedural disenrollments until they have a fix in place to ensure no eligible individuals are losing their Medicaid enrollment because of this issue,” said Dan Tsai, director of the Center for Medicaid & CHIP Services, in the briefing.

An official with MassHealth, the state’s Medicaid plan, said Massachusetts had avoided such problems in most cases, because the core system it uses to reenroll most people under the age of 65 looks at individual, not household, eligibility.

However, MassHealth did identify small populations where the eligibility system for people over the age of 65 and for individuals with disabilities was looking at household, not individual, eligibility.

The state is implementing an enhancement to its autorenewal process, and officials hope to renew insurance for affected populations that way. If they are unable to auto-renew this population, the state said it will defer looking at their MassHealth enrollment for up to 12 months.

It was unclear how many of those accidentally disenrolled might ultimately still not qualify for state insurance. Dan Tsai, director of the Center for Medicaid & CHIP Services said states were in various stages of fixing the problem, but did not provide a breakdown. He said some state fixes would take “months”

- See the full Boston Globe article.

Nursing facilities frequently attempt to force a facility resident’s family members or friends to become responsible for the resident’s bills. This generally happens after a family member or friend signs an admission agreement in haste and under stress on behalf of a resident who is unable to sign themselves. Such collection attempts are almost always illegal. Despite what a facility might say when attempting to collect, signing an admission agreement for another person does not make the signer financially liable for the resident’s stay in most cases. 

A new resource from Justice in Aging and the National Consumer Law Center, Can a Nursing Home Force a Resident’s Family and Friends to Pay the Bill?, summarizes the relevant legal framework and offers advocates and consumers tips for fighting back should a nursing facility attempt to make someone other than the resident financially liable. The resource also outlines what to look for when reading admission agreements to avoid being caught up in such a situation. 

Get the FAQ

- From New FAQ: What to Do When a Nursing Facility Tries to Force Payment from Friends or Family, Justice in Aging, September 7, 2023.

The federal government will again offer free Covid-19 tests through the mail starting Sept. 25, amid an uptick in the number of Covid hospitalizations.

Like in previous iterations, each household will be able to order four free testing kits for home delivery. The Biden administration said the tests are designed to detect circulating variants and can be used through the end of the year. Orders will contain clear instructions on when the tests expire.

The federal government reopened its partnership with the U.S. Postal Service in December, allowing people to request four free at-home Covid-19 tests per household. The program was paused in June to preserve the government’s remaining supply of Covid tests and because the number of Covid hospitalizations had plateaued.

A restart of the free testing program comes as Covid hospitalizations have ticked up in recent months.

“The president wanted to make sure that no one can go without tests. We will once again up our program to make sure Americans have access to a test,” HHS Secretary Xavier Becerra told reporters at a Washington pharmacy.

- See the full Politico article.

Information for MassHealth Members who are pregnant is now available on the MassHealth website. This new site includes the pregnancy checklist for MassHealth Members as well as covered services, coverage options for infants, behavioral health services, home visiting programs, social services and more. 

- From Application Updates: ACA-3 and SACA-2 & Information for Pregnant MassHealth Members, Massachusetts Health Care Training Forum, September 12, 2023.

Earlier this year, the Food and Drug Administration (FDA) approved the RSV vaccine. According to the Centers for Disease Control and Prevention, the RSV vaccine can help prevent lower respiratory tract disease caused by respiratory syncytial virus (RSV). RSV season varies from year to year, but usually starts in the fall and peaks in the winter. RSV can affect people of all ages but may be especially serious for infants and older adults.

Medicare Part D covers the RSV vaccine if it’s recommended for you by the Advisory Committee on Immunization Practices (ACIP), a government agency that gives advice about who should get certain vaccines. At this time, the RSV vaccine is recommended for adults over the age of 60.

There should be no cost to you to get this vaccine. This means your pharmacy shouldn’t charge you a copay or deductible to get the RSV vaccine. If you have Medicare Part D, it should be free to you.

If you have Medicare Part D and your doctor or pharmacy tries to charge you for the RSV vaccine, you should call 1-800-MEDICARE (1-800-633-4227) for help.

If you have non-Medicare drug coverage (like drug coverage from an employer or union), you should check to see its coverage rules for the RSV vaccine. Because this is a newer vaccine, it may not be listed on an insurance plan’s list of covered drugs yet, so you should check with your plan before making an appointment.

Remember that while the RSV vaccine is covered by Part D, your flu and COVID-19 vaccines will still be covered by Part B.

The Centers for Medicare & Medicaid Services (CMS) has finalized updates to Medicaid regulations that will make it easier for millions of low-income older adults and people with disabilities to get help with their Medicare costs. The new Streamlining Medicare Savings Program Eligibility Determination and Enrollment final rule simplifies the burdensome processes for applying and verifying income and assets for the Medicare Savings Programs (MSPs) across states.

The MSPs, run by state Medicaid programs, currently cover Medicare premiums and, in most cases, cost-sharing for more than 10 million older adults and people with disabilities who also have limited incomes.

Only about half of people eligible for MSPs are enrolled, so reducing the paperwork burden and streamlining the enrollment rules will help thousands of older adults get this financial help for the first time. The changes will also help the millions of people who currently have MSPs retain coverage during redeterminations and renewals.

Highlights of the final Streamlining MSPs rule include: 

• Automatically enrolling many people who receive Supplemental Security Income (SSI) into the Qualified Medicare Beneficiary (QMB) to ensure they get help with Medicare premiums and cost sharing.
• All Medicare-eligible individuals who receive Supplemental Security Income (SSI) are financially eligible for MSPs, but many are not enrolled because of burdensome and duplicative paperwork. Under the new final rule, many SSI recipients will now be enrolled automatically into the most comprehensive form of MSP coverage: the Qualified Medicare Beneficiary (QMB) eligibility group, which covers Medicare premiums and cost sharing.
• Maximizing states’ use of data from the Medicare Part D low-income subsidy (LIS) program to enroll people with LIS into MSPs and aligning MSP and LIS definitions of “family size.”
• Easing the burden on MSP applicants and enrollees to provide documentation of income and assets.
• Ensuring QMB enrollment for people who must pay Part A premiums is effective when Medicare entitlement begins.

To consider and address all of the more than 7,000 comments on that proposed rule, the agency plans to issue two final rules: This is the first; the second detailing remaining policies is anticipated in 2024.

Learn more about the new rule in CMS’s press release.

- From CMS Simplifies Enrollment in Medicare Savings Programs, Justice in Aging, September 19, 2023.

Massachusetts housing officials have announced they are launching a "90-day push" to reduce the number of vacancies in state public housing by the end of the year.
The initiative comes after an investigation by WBUR and ProPublica found nearly 2,300 of 41,500 state-funded apartments were vacant at the end of July — most for months or years — despite a housing shortage so severe that Gov. Maura Healey called it a state of emergency.

Massachusetts is one of only four states with state-subsidized public housing, and about 184,000 people are on a waitlist for the units.

The state’s plan focuses on providing financial and other assistance to local housing authorities, which maintain and operate the apartments, to help fill units.

The Executive Office of Housing and Livable Communities is "undertaking a new initiative to significantly reduce the number of state-aided public housing vacancies,” Fatima Razzaq, acting director of the public housing division, said in the memo. “We recognize the shared responsibility in tackling this challenge and are therefore initiating a 90-day push to assist with reoccupying units."

Among other measures, the state will help pay employee overtime costs for localities that have high vacancy rates and are approved for budget exemptions. It will also pay for contracting with other local agencies to assist with tenant selection and preparing units for new tenants.

In particular, Razzaq wrote that the state will closely monitor local housing authorities with vacancy rates above 10%. Housing management specialists will conduct weekly check-ins and provide technical assistance.

State housing officials will also visit local agencies where units are empty for more than 60 days — the amount of time the state allows local authorities to fill a vacancy — because they need certain types of repairs.

Because the state pays local housing authorities to take care of units whether they’re occupied or not, the vacant apartments translate into millions of Massachusetts taxpayer dollars wasted due to delays and disorder fostered by state and local mismanagement. Reasons for the vacancies include a flawed online system that the state created for selecting potential tenants, as well as under-funding for maintenance, renovations and staff.

In an earlier interview with WBUR, Healey said she asked Housing Secretary Ed Augustus to take the lead in fixing the problems and noted the state will centralize the screening process for people on the CHAMP waitlist.

As WBUR and ProPublica first reported, the state recently hired a marketing firm to take over a portion of the applicant screening to try to speed up the process of filing units.

House Speaker Ron Mariano said that the Legislature originally ordered the state to create a central waitlist (CHAMP) to address concerns that some local housing authorities weren’t offering units to people fairly in order of who applied. But Mariano acknowledged the new system created “some inefficiencies,” making it harder for local housing authorities to find new tenants.

Still, Mariano seemed skeptical about some of the claims that local housing authorities need more staff and funding to repair units and fill vacancies.

- See the full WBUR story.

What’s in the MA 2023 Tax Relief Package

After their latest round of negotiations, top Democrats in the State House unveiled a new $1 billion compromise tax package this week. The bill was passed by the legislature and is awaiting Gov. Maura Healey's signature or veto.

Here’s a breakdown of some of the biggest provisions:

For parents and caregivers: Massachusetts currently lets parents and guardians claim a tax credit of up to $240 for each child they have under the age of 13 — as well as dependents over the age of 65 and disabled dependents of any age. The new bill increases the credit to $310 per dependent for the 2023 tax year (i.e. the taxes you’ll file this coming spring) and then up to $440 for tax year 2024 and beyond.

• That means an eventual savings of $200 per child if you’re a parent already taking full advantage of the current credit.
• Additionally, the bill eliminates the current credit’s limit of two qualifying dependents, meaning potentially even more savings for those with three or more kids. For example, a couple with four kids would get an additional $1,280 a year starting in the 2024 tax year.

For lower-income residents: The bill would increase Massachusetts’ earned income tax credit (EITC) for low-income residents, from 30% of the federal EITC to 40%.

• The impact depends on your personal circumstances. For example, if you’re single with no kids and made the maximum qualifying amount for the EITC last year ($16,480), you’d save an additional $56. But if you’re a parent of two making the maximum ($49,399), you’d save over $600 more a year.

For seniors: Massachusetts allows lower-income residents aged 65 and older to claim a $1,200 credit on their taxes. The bill doubles that credit to $2,400.

• For the last tax year, the income limit for the credit was $64,000 for a single individual and $96,000 for a married couple filing jointly. It’s worth noting the eligibility rules depend on exactly how much you pay in property taxes or rent. But if you qualify, the change means you save another $1,200 a year.

Tax cap change: The tax relief package includes a House provision significantly altering a voter-approved tax cap law. The law, which returned nearly $3 billion to taxpayers in 2022, gives excess tax collections back proportionally to how much the taxpayer paid.

– Lawmakers said the change was needed to bring greater equity to the process.

Last year, when Beacon Hill owed nearly $3 billion back to residents, the highest-earning Bay Staters got rebate checks for thousands of dollars and lower-earning taxpayers received a few hundred dollars or less.

The bill would replace that proportional system with an equal payment for every taxpayer if the state collects enough tax revenue to trigger the law again, regardless of how much individuals paid in taxes that year.
Housing Provisions

Other changes in the compromise bill aim to incentivize new housing production by expanding the Housing Development Incentive Program, which would rise from $10 million to $57 million in the first year and then settle at $30 million annually thereafter, and increasing the annual authorization for the Low Income Housing Tax Credit from $40 million to $60 million.

Commentary from MassBudget

We commend (the legislature) for taking important steps to improve affordability for low- and middle-income households in Massachusetts. At the same time, our state fails to move toward racial and economic equity when we give away hundreds of millions of dollars to the richest families and large, profitable corporations. These dollars would be far better invested in a future for the Commonwealth that benefits everyone.

Several measures in the package do advance equity. The package closes the married filing separately loophole, a simple, evidence-based solution to eliminate an opportunity for high-income tax avoidance. Closing this loophole protects Fair Share revenue, preventing the loss of up to $600 million annually in education and transportation funding. Conferees deserve praise for taking this important step.
  
By including a reduction in the tax rate applied to short-term capital gains, the conference package provides another substantial benefit that goes overwhelmingly to the very highest income households in the state.

Lastly, with the shift to single sales factor apportionment (SSF), the conference package provides another costly corporate tax break. SSF is a method for determining how much of a corporation’s profits will be taxed which only considers its sales in Massachusetts. The change will give many businesses with customer bases in other states a substantial tax cut, resulting in a loss of $92 million a year for the Commonwealth. Instead, the benefits will flow to large, multi-state corporations and their disproportionately high-income shareholders.

While this package is not a clear win for advancing equity, it is an improvement over some earlier proposals. There is much to build on in the years ahead.

Sources and for More Information

•  https://www.wbur.org/news/2023/09/26/massachusetts-tax-reform-bill
• https://www.wbur.org/news/2023/09/27/massachusetts-tax-relief-bill-parents-renters-seniors
• Read the full summary of the bill and an analysis of how the Senate and House compromised in different areas.
• CommonWealth