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MGH Community News |
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MGH Community News |
| March 2022 | Volume 26 • Issue 3 |
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. |
Mass. to Open New Safety-Net Migrant Shelter, Adds Requirements Remain in Safety-Net Shelter The state has announced it will open a new Boston-area safety-net migrant shelter in April and will begin enforcing new eligibility rules to designed to encourage shelter residents to get jobs and find housing. "The whole idea of this is to divert people from our emergency shelter system, to get them on a different path," Gov. Maura Healey said. "This is about responsibly managing what we're dealing with in terms of capacity constraints." As of May 1, families will have to document "engagement in case management and rehousing efforts" monthly to stay eligible to stay at a state safety-net site. "During this recertification process, they will be evaluated on whether they have participated in state-provided services to help them move toward independence, including applying for a work authorization, participating in a workforce training program, submitting job applications, taking English classes, and engaging in a search for housing," Healey's administration said. Families will be permitted to remain at sites as long as they continue to engage in these services and activities, the state said. "While we understand state leaders are responding to a humanitarian crisis that is without precedent here in Massachusetts, we are deeply concerned that forcing families to reapply for emergency shelter each month will create unnecessary red tape, sow confusion, and ultimately, place more families on the street," Elizabeth Sweet, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition, said in a statement. "Implementing deadlines will solve little when immigrants are already striving to leave the emergency shelter system and provide for themselves and their families as quickly as possible," Sweet said in her statement. "Instead, state – and federal – leaders should focus on providing community service organizations the resources they need to support arrivals in pursuing work authorization, long-term housing, and case management services." The new policy does not apply to safety-net sites operated by the United Way of Massachusetts Bay. The administration also said the former Chelsea Soldiers’ Home facility, vacant and slated to be demolished since the administration opened a new, larger, state-of-the-art facility last year, will be converted into a safety-net shelter to be opened next month. At full capacity, the safety-net site will be able to accommodate approximately 100 families.
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Under the recertification process, families "will be evaluated on whether they have participated in state-provided services to help them move toward independence, including applying for a work authorization, participating in a workforce training program, submitting job applications, taking English classes, and engaging in a search for housing. Families will be permitted to remain at sites as long as they continue to engage [in] these services and activities," the administration said. The administration does not yet know whether families who fail to recertify would remain on the Emergency Assistance shelter waitlist. As of last week, there were 781 families on the waitlist for shelter. The decision on whether a family will be taken off the waitlist related to their recertification in overflow housing, according to an Executive Office of Housing and Livable Communities spokesperson, will depend on whether lawmakers and Healey decide to apply time limits to traditional Emergency Assistance sites — which both the House and Senate have now moved to do. Kelly Turley of the Massachusetts Coalition for the Homeless said she is concerned about the recertification process becoming another barrier to housing for homeless families, and hopes the administration does not use whether or not a family is successfully recertified as a deciding factor to remove them from the waitlist for more stable shelter. "The application for EA shelter and the overflow sites are interconnected, but there are reasons why a family in an overflow site — sometimes they are only there for a night, they can have intermittent access to services — it may be more challenging for families to comply with rehousing assistance than if they were in a more stable and traditional shelter with more time to access support," she said. She added that she hopes the new requirements, and possible consequences of failing to comply, are clearly communicated to families, many of whom don't speak English as a first language. "The new overflow sites are a bit of a bureaucracy on top of a bureaucracy. A lot of the rules aren't clear and are confusing for families," Turley said. "These families are experiencing trauma, whether from being homeless or homeless and traveling from their home countries. There's so much information coming at families while they're seeking longer-term housing as well as shelter. It can be overwhelming to understand everything that's expected of them." An administration spokesperson said they will ensure that information about the effects of a failure to qualify for certification is fully communicated to families in advance of the policy going into effect. The Chelsea site will become available for shelter use before another overflow site the administration has propped up comes offline. The Melnea A. Cass Recreational Complex in Roxbury has been used to temporarily accommodate about 100 families, or 400 individuals, since late January. However, the rec center will be converted back for community use by June 1. The recertification policy will only affect the Cambridge, Roxbury and Chelsea shelters, as Revere and Quincy are also clinical and safety risk assessment sites, Hand said. The House and Senate bills could push some people out of the EA system after nine months, marking a major shift in a state with a law guaranteeing access to shelter for eligible families and pregnant women. Sources and for More Information
Work Authorization for Migrant Arrivals Stagnant Since December Gov. Maura Healey has frequently pointed to getting more migrants authorized to work as a key step in moving people out of the state's overwhelmed emergency family shelter system, but the number of new arrivals who have work authorizations has stagnated since December. As the number of immigrants coming into Massachusetts has skyrocketed in the last year, Healey has repeatedly called on the federal government to expedite the work authorization process to help migrants who are eager to work leave state-funded housing and support their families financially. "The federal government is allowing people into the United States. And my position has been, if you're going to allow people in, then work with us states on getting people working -- expedite those work authorizations," Healey said last fall. The administration held two "clinics" in November with the U.S. Department of Homeland Security to help process work authorizations for shelter residents, where they said they helped "thousands" of new arrivals become eligible to work in the country. Though the clinics seemed to lead to a sharp increase in work authorizations, that number has since stagnated. As of Dec. 12, 2023, 813 newly arrived immigrants, refugees or asylum-seekers in Massachusetts' shelter system had federal work authorizations. That number climbed to 2,713 individuals two weeks later. Since late December 2023, however, the number of non-citizens living in shelters and able to legally work in the U.S. has remained unchanged, according to reports from the governor's administration. The most recent report on the EA family shelter system to come out of the Executive Office of Housing and Livable Communities showed that as of March 7, there were still only 2,713 of these individuals with work authorizations. A Healey aide said the work authorization numbers are derived from the U.S. Department of Homeland Security and recommended reaching out to them. In the time since late December when the number of new migrants eligible to work flatlined, hundreds of families have been added to the waiting list of folks waiting to be let into shelter. Around 400 families were on the waitlist -- waiting for a spot after Earlier this month, the Healey administration announced partnerships with eight resettlement agencies to help families exit shelter by connecting with resources such as housing, job searching and social services. Healey's office said the initiative, funded by money included in last year's supplemental budget, will enable families to access permanent housing. - See the full NBC Boston story.
Social Security Eliminates Overpayment Burden for Beneficiaries – Automatic Overpayment Recovery Rate Reduced to 10 Percent Social Security announced it will decrease the default overpayment withholding rate for Social Security beneficiaries to ten percent (or $10, whichever is greater) from 100 percent, significantly reducing financial hardship on people with overpayments. When a person has been overpaid, the law requires the agency to seek repayment, which can create financial difficulties for beneficiaries. As of March 25, 2024, the agency will collect ten percent (or $10, whichever is greater) of the total monthly Social Security benefit to recover an overpayment, rather than collecting 100 percent as was previous procedure. There will be limited exceptions to this change, such as when an overpayment resulted from fraud. There will be a short transition period where people will continue to experience the older policy. People placed in 100 percent withholding during this transition period should call Social Security’s National 800 Number at 1-800-772-1213 to lower their withholding rate. The change applies to new overpayments. If beneficiaries already have an overpayment with a withholding rate greater than ten percent and would like a lower recovery rate, they too should call Social Security at 1-800-772-1213 or their local Social Security office to speak with a representative. If a beneficiary requests a rate lower than ten percent, a representative will approve the request if it allows recovery of the overpayment within 60 months – a recent increase to improve how the agency serves its customers from the previous policy of only 36 months. If the beneficiary’s proposed rate would extend recovery of the overpayment beyond 60 months, the Social Security representative will gather income, resource, and expense information from the beneficiary to make a determination. Learn about Overpayments and Our Process and read our Press Release. This change and the adjustment to 60-month repayment are part of four recently announced key updates to address improper payments. The agency also is working to reduce wage-related improper payments by establishing information exchanges with payroll data providers that will significantly reduce the number of improper payments, once implemented. Additionally, people have the right to appeal the overpayment decision or the amount. They can ask Social Security to waive collection of the overpayment, if they believe it was not their fault and can’t afford to pay it back. The agency does not pursue recoveries while an initial appeal or waiver is pending. Even if people do not want to appeal or request a waiver, they should contact the agency if the planned withholding would cause hardship.Social Security has flexible repayment options, including repayment of as low as $10 per month. Each person’s situation is unique, and the agency handles overpayments on a case-by-case basis. - See the full SSA Blog post.
Social Security to Remove Food as “In-Kind Support” The Social Security Administration published a final rule, “Omitting Food from In-Kind Support and Maintenance (ISM) Calculations.” The final rule announces the first of several updates to the agency’s Supplemental Security Income (SSI) regulations that will help people receiving and applying for SSI. People applying for and receiving SSI must meet eligibility requirements, including income and resource limits. Under our old rules, ISM includes food, shelter, or both a person receives – the agency counts ISM as unearned income, which may affect a person’s eligibility or reduce their payment amount. Under the final rule, beginning September 30, 2024, the agency will no longer include food in ISM calculations. The new policy removes a critical barrier for SSI eligibility due to an applicant’s or recipient’s receipt of informal food assistance from friends, family, and community networks of support. The new policy further helps in several important ways: the change is easier to understand and use by applicants, recipients, and agency employees; applicants and recipients have less information to report about food assistance received from family and friends, removing a significant source of burden; reducing month-to-month variability in payment amounts will improve payment accuracy; and the agency will see administrative savings because less time will be spent administering food ISM. To read the final rule “Omitting Food from In-Kind Support and Maintenance Calculations,” visit Federal Register: Omitting Food From In-Kind Support and Maintenance Calculations. - See the full SSA Blog post. Also see: Regulatory Changes to In-Kind Support Rules Expand Access to SSI - Justice in Aging
MBTA Would Offer Half-Price Fares to Low-Income Riders Pending Funding The MBTA board of directors has voted in favor of offering a reduced fare for adults with low incomes across its entire system, moving advocates to tears and marking the most significant step toward implementing the long-awaited program. For some riders, it could translate into hundreds and even thousands of dollars of annual savings. Now, the agency just needs to come up with the cash - through budget funding from the State House. Advocates got even more than they expected. Originally, the T planned to keep some trips provided by the T’s paratransit service, The Ride, at full price for people with low incomes. But at the board meeting, riders urged T board members to reconsider the agency’s decision to exclude “premium” trips, those that originate or finish more than three-quarters of a mile from T bus or subway service. Those trips currently cost $5.60. After hearing from several advocates, Secretary of Transportation Monica Tibbits-Nutt proposed an amendment to also include the “premium” service in the low-income fare program. The board of directors voted to approve it to a standing ovation from advocates. Advocates are hoping this time is for real. At one of the last meetings of the T’s previous oversight board in June 2021, members instructed the T to present proposals for a nine-month, low-income fare pilot program and begin implementing it as soon as July 2022. That never happened. The T expects a new low-income policy systemwide will impact around 62,000 riders on the agency’s bus, train, and ferry service and 28,000 riders on the T’s paratransit service within the coming years. Some worry, however, that making paratransit service more accessible, without staffing it accordingly, could overwhelm the system. Michele Stiehler, the T’s manager of paratransit operations, said that if premium trips are included in the low-income fare program, the on-time performance of the entire paratransit system could suffer. The Ride has about 22 percent fewer drivers than it needs for current service levels, Stiehler said. The T board of directors also voted to approve two other fare changes. Riders will no longer receive change, from paying cash on board, in the form of a paper CharlieTicket on the Green Line, Mattapan Line, and buses. Riders instead will have to load cash onto a CharlieCard. And the T is now extending its $10 commuter rail weekend pass to include federal holidays that create three-day weekends. The new system could start as early as this summer. What's the discount? Tickets and passes will be discounted 50%. Including on commuter rail. Who's eligible? Adults between ages 26 and 64 with incomes below 200% of the federal poverty level. For example, that would include a single person who makes up to $30,120 per year, or a household of four with an annual income up to $62,400. What T services are covered? The reduced fare program will apply to all modes of transit on the MBTA, including the commuter rail and the T's paratransit service, The RIDE. Reduced fares will also apply to The RIDE's premium service area after MassDOT Secretary Monica Tibbits-Nutt added an amendment to include it Thursday. How to sign up? An online application will be available in multiple languages. The T will also partner with community groups to help people complete applications in-person. The application will use information from the Registry of Motor Vehicles and the state's Office of Health and Human Services, which administers social programs, to verify identity and income. Riders can also prove eligibility through enrollment in SNAP and MassHealth programs. The T already offers reduced fares to students, low-income young adults and seniors, but the new reduced fare program will benefit more riders. Transit officials said 62,000 riders will be eligible for discounted fares under the new program. And the MBTA estimates the expanded eligibility will lead to 8.1 million additional trips on the transit system. How much will it cost?T officials said they expect the program will cost about $25 million in the first year, and grow to about $50-$60 million over the next five years. Cost has long been a hurdle for the cash-strapped transit agency in getting the low-income fare program off the ground. But the T got a bit of a lifeline earlier this year when Gov. Maura Healey outlined $45 million in her proposed budget to help get the discounted fare program started. When will it begin? The program is expected to be implemented this summer, if funded. Sources and for More Information
Congress Restores Federal Benefits Eligibility for COFA Citizens in the U.S. and VA Care for COFA Veterans The Association of Asian Pacific Community Health Organizations (AAPCHO) this month released a statement following the restoration of federal public benefits eligibility for Pacific Islanders from the Marshall Islands, Palau, and the Federated States of Micronesia (collectively the Freely Associated States or FAS) living in the United States. Excerpts: The Consolidated Appropriations Act of 2024, signed into law by President Biden on March 9, 2024, included the text of the Compact Impact Fairness Act (CIFA), which received bipartisan support in the Senate and House of Representatives. The Act added Compacts of Free Association (COFA) citizens living in the U.S. to the list of noncitizens eligible to receive federal public benefits. Congress also waived the five-year bar so eligible COFA citizens can apply for federal benefits as soon as they enter the U.S. This will allow COFA citizens to apply for programs such as the Children’s Health Insurance Program (CHIP); Supplemental Nutrition Assistance Program (SNAP or food stamps); Temporary Assistance of Needy Families (TANF); Supplemental Security Income (SSI); and FEMA Individual and Household Programs. Congress previously restored Medicaid eligibility in 2020. “For nearly 30 years, our brothers and sisters from the Freely Associated States have been unable to get the support they need because of an error in federal law,” said Jeffrey B. Caballero, executive director of AAPCHO. “This legislation builds on the success community advocates made in 2020 when Congress restored Medicaid eligibility for COFA citizens, and it will help ensure that they are not left out of important programs such as CHIP, SNAP, FEMA emergency assistance, and TANF. We are also pleased that Congress extended much-needed support for U.S. veterans living in the FAS to get the health care they need without having to leave their home islands, including by establishing VA partnerships with community health centers in the FAS. The funding package also included text of the Care for COFA Veterans Act to expand health care to veterans living in the FAS. The legislation removes restrictions on the VA from providing services to veterans residing in the FAS, including by permitting contracts with community health centers and other community clinics, and establishing clinic options via telehealth. It would also allow VA to ship medications to veterans in the FAS and reimburse veterans for travel from their home countries to the U.S. for care connected to the military service. - See the full AAPCHO statement.
Competitive Energy Suppliers Say They Can Save You Money - Regulators Say it’s a Scam Across Massachusetts, the complaints sound similar: A person discovers their electric bills have spiked, and when they look into it, they find that the company providing their electricity isn’t who they expected — instead of a utility like National Grid or Eversource, it’s a third-party provider they’ve never heard of. There was the woman in Chelsea who learned that a door-to-door salesman for a so-called competitive electric supplier allowed her minor son to sign up the household. There was a Natick resident who was signed up after showing their electric bill to someone pretending to be from Eversource, badge and all, who had knocked on the door. There was a blind 77-year-old woman in East Falmouth who swears she never signed up for a competitive electric supply plan because she doesn’t sign things without a friend at her side, but whose name — misspelled — ended up on official documents. These complaints are among hundreds that The Boston Globe and WBUR received as part of a public records request to the state. And for every example of someone who didn’t knowingly sign up for a competitive supplier, there’s another example of someone who signed up for a plan with a low rate, only to have it balloon without warning a few months later. Each story is troubling on its own, but together they paint a picture of an industry that experts say is making money by taking advantage of residents — particularly older adults and those in low-income and minority neighborhoods. When it comes to state energy policy, “there’s no one issue that has more implications for equity than this,” said Larry Chretien, executive director of Green Energy Consumers Alliance, an advocacy group that supports banning the industry. When the competitive supply market was created by regulators in the late 1990s, the goal was to drive down prices through increased competition. Proponents of the industry also say it’s a way to get more green energy into the grid. And some consumers say they did, in fact, benefit by shopping online for competitive plans to secure lower rates. But as evidence of deceptive sales tactics mounts, political forces in Massachusetts are aligning around a Senate bill that would enact a first-in-the-nation ban on the industry’s ability to sign up new residential consumers, effectively phasing it out. Support for the bill comes from all levels of government in the state including Governor Maura Healey, Attorney General Andrea Campbell, and Mayor Michelle Wu of Boston. Despite the political momentum and broad support for the bill, many competitive suppliers and a handful of House legislators are pushing back. They’ve introduced a competing bill to reform the industry, rather than scrap it. Consumers, they say, should have the right to choose their energy plan. Those who support banning the competitive market say the cost of regulating a “predatory” industry is too high — both in state resources and in the harm caused, particularly to vulnerable consumers. Since the market’s inception, some savvy consumers have been able to save money by shopping around for lower-cost plans. But they are the exception, not the norm. The majority of people on competitive electric supply plans paid more than they would have on their utility’s basic service rate — sometimes much more. Data collected by the Massachusetts attorney general’s office shows that between 2015 and 2021, residents who signed up for competitive electric supply plans paid $525 million more than if they had continued buying electricity from their utility. Low-income residents were nearly twice as likely to be enrolled with competitive electric suppliers, and they consistently lost the most money. “This has been a 25-year experiment. It’s fair now to conclude on the basis of the evidence that [the market has] failed to produce value for large numbers of consumers,” said Senator Michael Barrett, the Democratic lawmaker who will help lead negotiations on a climate bill later this year. “At some point, you have to throw in the towel.” In about half of all Massachusetts cities and towns, residents have a third option for buying electricity beyond their utility’s plan and a competitive supplier. It’s called municipal aggregation. In a municipal aggregation program, city officials buy power from competitive electric suppliers on behalf of their customers. Unlike individual residents, municipalities can hire lawyers and experts to vet any contract and make sure what they buy is a good deal. And indeed, a 2023 report from the University of Massachusetts Amherst found that nearly 80 percent of municipal aggregation programs offered reduced electricity costs compared to utility basic service rates. Additionally, 60 percent were rated “green,” meaning they offered a higher percentage of renewable energy than required by the state. Municipal aggregation has widespread support throughout Massachusetts, and in the last few months, the pace of new approvals has started to pick up. That’s heartening for people like Barrett who hope this legislative session brings about the end of the residential competitive supply market and a boom in municipal aggregation. Municipal aggregation is a great compromise, he said. It keeps these companies in business, while introducing a middleman to protect individual residents. - See the full Boston Globe article (in collaboration with WBUR)
MGB ACO Flexible Services Offers Small Home Modifications and Special Asthma Services As we continue enrolling MGB ACO patients into Flexible Services for housing help, we wanted to make you aware that Flex Services can also help with housing assistance in other ways such as referrals pertaining to asthma and small housing modifications. For housing modifications overall, services include:
More specifically for asthma, services include
We hope that with this information, that you all will be able to keep an eye out for patients that may be in need of services such as these and send them our way. It is our goal to have patients benefit from all of our services and your referrals play a crucial role in connecting those in need with the supports we are able to provide. - From Flexible Services - Asthma and Home Modification Referrals, on behalf of Bria Ellis Hinds, MGH Outreach and Resource Navigation Group, March 21, 2024.
MassHealth Permanently Eliminates Copayments MassHealth this month has released Eligibility Letter 248 this month, announcing that, effective April 1, 2024, copayments are eliminated for MassHealth members. Copayments had been temporarily eliminated since May 1, 2023; this update extends this policy indefinitely. This policy includes members in MassHealth Fee-For-Service (FFS), Primary Care Accountable Care Organizations, Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), One Care Plans, Senior Care Options (SCO) Plans, and Program of Allinclusive Care for the Elderly (PACE) Organizations. This does not apply to Children’s Medical Security Plan (CMSP) members – CMSP members must still pay copays. - See the full Eligibility Letter (mass.gov) and Pharmacy Facts
Recourse for Privately Insured Patients Who Get Surprise Balance Bills For privately insured patients, surprise medical bills can arise from either having to pay a high deductible, or from “balance billing.” Typically, health plans negotiate payments to in-network providers. Out-of-network providers may directly bill privately insured patients the difference between the typical in-network health plan payment and the full charge, also known as “balance bills”. In these cases, patients can be liable for the balance bill in addition to any deductible, coinsurance, or copay under the health plan. The No Surprises Act prohibits many of these balance bills starting in 2022. Privately insured patients (including those with employer-based coverage, non-group plans, and grandfathered plans) are protected from certain surprise balance bills. The surprise balance billing protections require private health plans to cover out-of-network claims and apply in-network cost sharing (deductibles, copayments) for certain covered benefits. The law prohibits certain providers, hospitals, and air ambulance from surprise balance billing patients for out-of-network care, unless the patient consents ahead of time. The new protections require plans and providers to take the patients out of many of the most common payment disputes. Though it is possible that patients still get balance bills, including because of plan or provider billing mistakes, the bill is not covered under the new law (for example, ground ambulance rides, non-covered services, patient consents to out-of-network care costs), or the health plan denies the claim completely as not covered by the plan. The patient might get balanced bills, for instance, if the patient’s plan incorrectly processes a claim or applies out-of-network cost-sharing amount when the NSA prohibits it. A patient could get billed more than they ought to be, for example, if the plan does not recognize that a claim is subject to the No Surprises Act, or because of a billing oversight. Patients can appeal these mistakes using the plan’s internal claims and appeals procedure. Under the federal law, the patient has the right to appeal a health plan denial (called an adverse benefit determination or “ABD”). ABDs also include plan decisions to apply the incorrect cost-sharing amount. Once the adverse benefit determination has been made, the health plan must give the patient at least 180 days to file an internal appeal. For post-service claims, the plan must then complete the internal appeal no later than 60 days after it is filed. If the plan upholds its denial, the patient has a new right under the NSA to ask for an independent external appeal for NSA compliance issues. Federal regulations provide several examples for when NSA-related decisions can be reviewed by an external reviewer, including a decision about whether a specific claim involves an item or service that is covered by the NSA as a surprise bill. Under current law, any health plan ABDs must include contact information for state consumer assistance programs (CAPs) and notice that such programs (in states where they exist) can help people file an appeal. Consumers could reach out to CAPs to get an assessment of whether the bill they received is valid. Additionally, as part of the No Surprises Act, the Centers for Medicare and Medicaid Services (CMS) has established resources for patients to seek review of their medical bills (through this website: https://www.cms.gov/medical-bill-rights/help/submit-a-complaint or by calling the No Surprises Help Desk at 1-800-985-3059 which is available 24/7 and through holidays). This no-wrong-door complaints system is available for consumers who are concerned their plan may have incorrectly denied or covered a surprise medical bill. Meanwhile, however, if a plan incorrectly denies or covers a surprise bill and the patient does not recognize the mistake in order to be able to either appeal or ask for a state or federal review, the patient might get stuck with the bill. While patients appeal, there is no federal rule preventing providers from trying to collect the outstanding bill. For incorrect bills, if the patient appeals, the out-of-network provider might be able to bill the patient for the full charge while the appeal is underway. Patients who are unable to pay the outstanding bill may be referred to collection agencies. Later, if the patient prevails on the appeal, the health plan would need to reprocess the claim, this time following the No Surprises Act rules, and the out-of-network provider would then be required to refund the patient for any amount collected in excess of the applicable in-network cost sharing amount. Most patients do not know about the new surprise billing protections and likely also do not know of resources available to seek recourse for incorrect medical bills. It’s advisable to ask about the cost ahead of time, when possible. Additionally, when patients get a large, unexpected bill, a good first step is to call the health plan. New federal resources allow patients to submit complaints and get a response from the federal government. The federal process does not provide a determination or help the consumer fight a bill with the payer. Patients may have little recourse, however, if their plan does not cover certain items or services, or if their surprise balance bill is not protected under federal law. What resources are available for privately insured patients who get surprise balance bills? | KFF
Sen. Warren Cautions Seniors About Medicare Advantage Plans Massachusetts U.S. Sen. Elizabeth Warren is warning buyers to beware of some Medicare Advantage health insurance plans for seniors. At a recent meeting with health care providers in Boston, Warren said many commercial insurers are "boosting their profits with a lot of denials of care," and "threatening the solvency of the Medicare system overall." Medicare Advantage plans are administered by private insurers who are paid by the federal government's Medicare health insurance program. The plans launched more than two decades ago as a private-sector option for Medicare that are designed to improve efficiency. An estimated 31 million Americans are covered by the plans nationally, including about 1.4 million people in Massachusetts, according to Warren's office. Medicare Advantage plans tend to offer more services than traditional Medicare coverage, such as dental and vision benefits. But Warren, a Democrat, said they often don't cover some other services that beneficiaries expected. She said her office has heard from a number of people who were frustrated after they were denied access to medications that used to be covered by their insurer, or learned certain facilities were deemed out of network by the insurer. "Frankly, if you lift the hood and look underneath you find out that it's pretty modest coverage," Warren said. - See the full WBUR story.
Study - Medicare Advantage Patients Get Less Home Health Care Medicare Advantage patients were found to get skimpier home health care and worse outcomes than their counterparts in traditional Medicare in a study published in JAMA Health Forum. Why it matters: With more than half of Medicare beneficiaries in Medicare Advantage plans, there's growing concern about how the plans are run, including whether their guardrails around coverage are reducing access to care.
What they found: Medicare Advantage patients got fewer home health visits from nurses, therapists and other classes of providers except social workers — and nearly two fewer days of service between admission and discharge — based on a review of about 285,000 patients who had care between 2019 and 2022.
The bottom line: Differences in home health services can weigh heavily on Medicare Advantage patients, who are likelier to live alone with less support and often don't need the care until they're in dire medical straits. - From Axios, 3/4/24.
How is it That Only Eight Massachusetts Housing Authorities out of 120 Eligible Have Accessed HUD’s Foster Youth to Independence vouchers? As two young women, ages 21 and 22, who spent most of our childhoods in the custody of the Department of Children and Families, we want to share our experiences aging out of the foster care system. Massachusetts is accessing far too few Department of Housing and Urban Development Foster Youth to Independence vouchers — since 2019, the state has received only 88 vouchers and used even fewer. We are living this reality. There are limited placement options for older youth in DCF care, especially once they turn 18. It is not accurate to say youth opted out at 18 when neither the state nor federal government have provided them a place to live, and most in foster care haven’t been told that applying for a housing voucher is an option. The message we get is that we are not wanted. If it were up to DCF, our cases would have been closed at 18 and, like so many other youth, we would have been homeless or worse. But we learned about our rights from More Than Words, a nonprofit in Waltham and Boston, where we are part of a team working to run a business while getting our lives on track. The staff helped us advocate to keep our DCF cases open. They supported both of us in finding housing through the nonprofit’s Single Room Occupancy program and worked with DCF to continue to provide some funding for us as we learn to live on our own. But now what? Even young adults who have families and resources aren’t expected to be on their own without support at 18 or even 22. They are in college or they live at home. Yet the state and society seem to expect so many of us who have been in the system to somehow stand out there on our own without support. And then people wonder why there are so many young people experiencing homelessness. Both of us recently learned about FYI vouchers from More Than Words; nobody from DCF told us about the program designed specifically for people like us. Our social workers didn’t even know the program existed. It feels like DCF and the government are very good at making sure we don’t have enough information. At 18, most youth don’t know what their rights are and that there are options. DCF simply releases youth like us out into the world on our own. This isn’t on the social workers who are working within a broken system. Why are the people in charge, the leaders in government, not putting resources into helping youth get these vouchers? How is it that only eight out of 120 housing authorities have accessed these vouchers? How is it that Massachusetts doesn’t make this a requirement so that thousands of youth have them instead of just 88 people? We are both about to have our DCF cases closed at 22. Once we age out of the system, this voucher will be our best chance to receive support for housing. We are waiting on a new round of vouchers to be released by HUD, but the system is stuck. It can’t issue more vouchers until the first round is used by other youth — and there is no good system to help all those youth get the vouchers and find places to use them. Nobody appears to be in charge of managing it. We are fortunate to have the help of More Than Words, but HUD, DCF, and state housing authorities need to do their job and find a real solution. Nationwide up to 50 percent of homeless youth are coming right out of the foster care system. If Massachusetts wants to solve youth homelessness, it should start here. We are in your custody. DCF staff are so quick to close cases and blame youth for not doing what they should, not following all the rules, not being easy enough to deal with. But where are legislators, DCF, lawyers, judges, and others responsible for supporting us as we find our way? Every youth in Massachusetts who is in DCF care should know about this voucher and every youth who needs one should get one. If society wants to stop youth homelessness, the state should stop making youth homeless. Massachusetts should start caring for the young people in its custody and creating real housing options for them even after they age out of the foster care system. And then when they do age out, the state must ensure they get FYI vouchers to support them as they prepare to be on their own. Then we’ll have a fighting chance. Naishalys Negron and Emperis Mathews are members of the More Than Words nonprofit organization. - From the Boston Globe.
Why Advocates Say a 9-Month Shelter Limit Will Worsen the MA Housing Crisis Massachusetts looks poised to join cities such as Chicago and New York City in implementing limits on shelter stays as a surge of new arrivals strain resources unlike ever before. The Massachusetts Senate has passed its version of a shelter funding bill that seeks to limit shelter stays to a maximum of nine months with extensions under certain conditions. Like a previously approved House version, the bill represents an effort to modify the state’s 1983 right-to-shelter law since the surge of new arrivals began in the fall of 2022. Leaders from two agencies who work directly with new arrivals and homeless Massachusetts families told MassLive that limiting families in the state shelter system to nine months will create a greater need for helping people find stable jobs and adequate housing. Massachusetts lawmakers’ efforts to curtail the length of shelter stays follow similar steps taken in other cities across the country. Agencies such as the International Institute of New England help migrant families resettle in Massachusetts with language classes, career development, and “If you are new to the United States, if you do not speak English, you need assistance from people who speak your language to help you find an apartment. You need support from the state government,” Thielman said. “There are not enough helpers,” he added. “There’s not enough people helping so the timeframe is not realistic given the limits on what it takes to actually find an apartment.” La Colaborativa, an immigration social service agency based in Chelsea, runs a day shelter for migrants staying at shelters, although it is not one of the eight resettlement agencies contracted with the state. “Ultimately, if the state decides to shorten the shelter stay to nine months, we would emphatically urge legislators to properly fund the rapid rehousing services necessary to stabilize support and rehouse residents within that nine-month period,” said Alex Train, the chief operating officer for La Colaborativa. “If we simply shorten the period without deeply investing in those rehousing services, we’re going to be grappling with another surge of homelessness in nine months.” Train said he recognized that the state is under immense budgetary pressure and the shelter stay limits sought by lawmakers are reckoning with financial realities, yet families continue to face challenges exiting the shelters due to elusive economic opportunities. He’s seen clients at La Colaborativa who gravitate to healthcare fields, construction trades, and entrepreneurial pursuits. A group of women who attend the Chelsea day center are working to start their own cleaning business that would be cooperatively owned, according to Train. “It’s a group of women who used to own a commercial cleaning company in Haiti,” he said. “Many of these residents who fled violence and persecution in Haiti and Venezuela used to work in the medical industries back in their home counties,” Train said. Many were also skilled carpenters, plumbers and electricians back home. “Even once folk are in possession of work authorization, they have those skills and knowledge base solidified, and they have the support systems behind them, they’re still being confronted with a lot of racism and general skepticism once they leave the program,” Train said. The Massachusetts Legislature is looking at two proposals to address the soaring costs of the state’s emergency shelter system as tax revenues lag. Both versions of the bill seek to limit shelter stays for some people to a maximum of nine months while creating a “rehousing plan” for all families and pregnant women in the system, which could allow for extensions for some families. “If the money were to run out without any action on the plan, we would be talking about thousands of these families suddenly on the street in many communities across the state. This is an unacceptable and equally irresponsible outcome,” said the chamber’s top budget writer, Senate Ways & Means Committee Chairperson Michael J. Rodriques, D-1st Bristol/Plymouth, according to the Boston Herald. During an appearance on WBUR’s “Radio Boston” program on Tuesday, Healey said she supports time limits on family shelter stays. But the Democratic governor demurred when host Tiziana Dearing asked if nine months is the right number. - See the full MassLive article.
Opinion: Mass. Wheelchair Repair System is a Disgrace As wheelchair users, we understand that our chairs are much more than just vehicles to get us from point A to point B. They are a lifeline and a connection to our livelihoods and careers. They allow us to feel safe when we’re out in our communities and enable us to participate in and enjoy the full benefits of society. So, when our wheelchairs break, and become unsafe and unusable, we are essentially trapped in our homes – quite literally in bed – and are cut off from our daily, independent lives because we are unable to take proper care of ourselves without help (which is scarce). Unfortunately, the wheelchair repair system in Massachusetts is broken. A brand new wheelchair can take one to two years to arrive. It’s common to wait three months or more for a spare part – and we all too often receive the wrong or defective parts, which means the waiting game starts all over again. There also are never any loaner chairs available to use in the interim. This means we miss work, we have to cancel our plans with friends and family, and we can’t even run to the store if we need something. It’s beyond an inconvenience. It’s a violation of our civil rights. Such repeated indignities take a toll on your overall mental health – something the wheelchair repair companies simply don’t seem to understand or care about. A bill before the Massachusetts House would, if passed, be a great first step on the long road to fixing this broken, unjust system. The legislation aims to expand consumer protections to ensure broken wheelchairs are both assessed and repaired in a timely fashion. Under the bill, all wheelchairs sold in Massachusetts would also come with a two-year warranty that would cover loaner chairs while users await the repairs. The bill unanimously passed the Senate in January, and we urge the House to follow suit. There are only two wheelchair repair companies in the state, and because of the way the insurance is set up, we are required to use only these two firms. Neither of the companies keeps spare parts on their shelves, so they have to order them. We never have access to loaner chairs, and if we go outside the network for help and the vendor finds out, they will cancel our warranties. All wheelchair users in the state must go through the same byzantine process. The two repair companies are run by private equity, which means their main motive is profit – and wheelchair repair isn’t exactly a money maker. That’s why we’ve seen the quality of our brakes and other replacement parts get shoddier and less safe with each passing year. One of the companies covers a large region with more than 1,000 wheelchair users and has only two technicians on staff to come to people’s homes. Both companies consistently cut costs and ignore our needs because they know we have no other alternatives. It’s the modus operandi of private equity, a system that preys upon vulnerable people and flailing corporations. Private equity and health care is a mismatch. Look no further than the Steward Health Care debacle. The havoc that Steward has wreaked continues to threaten hospital closures in communities that can’t afford to lose access to health care. Companies bought by private equity firms are 10 times more likely to go bankrupt as those that aren’t. This is what happens when you monetize people. Nobody in any other industry would be allowed to operate this way. Pamela has been stranded at home – and once even in a public restroom – not only because of faulty parts, but also because the repair company consistently sent her the wrong parts. Once, while attempting to get to her car, the caster (a fork attached to a small front wheel) came off her wheelchair and she fell over onto the pavement breaking her hip. She ended up missing 10 weeks of work but because she was forced to remain homebound until a new caster could arrive. Worse – and adding to the stigma of wheelchair users – none of her coworkers could understand how a simple part, ordered with the serial number of her wheelchair, could possibly take 10 weeks to arrive. We never know when our chairs are going to break, how long we’ll have to wait, or how long it will affect our well-being and livelihoods. Right now, we need the support of our legislators, the able-bodied, and other advocates to raise awareness of the plight of the disability community in Massachusetts and help us advance H.446/S.184. While much more needs to be done, holding the industry to account and requiring them to provide responsive customer service is not only the right thing to do, it’s a matter of basic civil rights. - See the full Commonwealth Beacon opinion piece.
Opinion: Remove the Social Worker Exam Requirement and Pay SW Interns My supervisor at my master of social work internship would often look at me at the end of the week and ask what I would be doing on the weekend. I’d always laugh/cringe simultaneously, and reply that I will be at work. A typical week is working six days a week - two days are unpaid at my field placement. I often joke that I “pay to work” because I pay to be enrolled in field education every semester. Unfortunately, this “joke” is the reality for many master of social work students. To complete a master of social work degree in Massachusetts, most social work students must complete over 1,000 hours of a typically unpaid supervised internship while paying for our education. We must find one or two internships to complete the 1,000 hours. Due to the lack of social workers in the state and the limited capacity for most, some students experience a challenge in finding an internship placement. I myself had this experience while looking for a field placement while obtaining my degree. If it were to pass, the so-called SUPER Act would do three things to support our workforce:
We are facing a massive shortage of behavioral health providers in Massachusetts, and the behavioral health crisis has gotten worse. We need less barriers to entry into the profession, not more. On top of a financial barrier to entry, students also have to take an exam to be licensed at the licensed certified social worker level and to work in most settings once they graduate. This exam has been shown to have lower pass rates for Black test takers, people who do not speak English as their primary language, and older exam takers. This lower pass rate in those populations speaks to the bias of the exam itself and the disparities it causes within the profession. The licensed certified social worker exam does not show who is a competent social worker. It simply indicates who can pass an exam. As someone who struggles to do well on exams because of the narrow focus but has been successful in my master’s education, I worry that the exam only serves as a further barrier to entry into the profession. I also fear it could potentially deter competent clinicians we desperately need. Furthermore, other states have succeeded in increasing the number of social workers by removing the exam requirement. The removal of the exam would help increase the number of social workers in the profession in Massachusetts, as it would eliminate the need to retake the exam if individuals did not pass it the first time and eliminate the financial barrier that people face with the $230 registration fee. Eliminating the exam would not decrease the number of qualified master’s level social workers in the profession, as social workers would still have to go through over 1,000 hours at an internship(s) as they complete their master’s degree, course work, and then submit multiple references to the state before being approved for licensure. I can’t help but wonder for myself and my classmates, what if we go through all of this and then won’t be hired simply because we can’t pass a standardized exam? I have a history of doing poorly on exams, so this is a genuine fear. Ultimately, if we want to solve the behavioral health crisis in the Commonwealth, we need to remove known barriers. Removing the licensed certified social worker exam requirement and providing continuing education credits to those who supervise other social work students will cost the Commonwealth nothing. We have the funding to provide stipends, as the FY24 state budget allocated $25 million of the leftover federal funds that are allocated for the behavioral workforce to go toward paid field placement stipends. There has been an identified problem with a need for more trained master’s level social workers, and this bill offers a reasonable solution that does not cost the taxpayers money. We need to pass the SUPER Act today. - This piece appeared in Commonwealth Beacon.
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