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

State officials will start implementing a one-month limit on families staying in safety-net shelters on May 1, with new requirements in order to extend their time.

Gov. Maura Healey's office announced the new policy as the overflow sites swell with families in need of housing and unable to secure a spot in the larger emergency shelter system that Healey capped at 7,500 families last fall.

Families will need to show documented engagement in case management and rehousing efforts monthly to remain eligible to stay at a safety-net site, also called overflow sites, where families have temporary beds available to them.

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 policy does not apply to safety-net sites operated by the United Way of Massachusetts Bay, the governor's office said.

United Way of Massachusetts Bay is also helping families find overnight shelter in partnership with the state, with nine safety-net sites accommodating about 124 families total, Hand said.
A representative from United Way did not immediately reply to a question about why the nonprofit would not follow the same policy as state-run facilities.

It's unclear what impact the new policy will have on the numbers of migrants in shelters. The Healey administration is under political pressure to control the millions of dollars in costs associated with assisting unhoused families, roughly half of whom are new immigrants.

Sarang Sekhavat, chief of staff for the Massachusetts Immigrant and Refugee Advocacy Coalition, said the new policy may further burden those helping shelter residents: "To add this recertification process on top of that monthly for thousands of families — it's just a lot more work for the folks on the ground to be doing that we, frankly, just don't have the time to do."

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.

Kelly Turley of the Massachusetts Coalition for the Homeless saidshe 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.

United Way of Massachusetts Bay is also helping families find overnight shelter in partnership with the state, with nine safety-net sites accommodating about 124 families total, Hand said. The new recertification policy does not apply to safety net sites operated by the United Way of Massachusetts Bay, the governor's office said.

- See the full WBUR story

Gov. Maura Healey has signed into law a new nine-month limit on how long families can live in Massachusetts emergency shelters (not to be confused with overflow shelters- see accompanying article). Two additional 90-day stays will be available to those who are employed, participating in an approved training program, or meet protected criteria such as: "seeking to avoid educational interruptions for a child or children enrolled in public schools," those who are pregnant or recently gave birth, people with a diagnosed disability or "documented medical condition," those to whom domestic violence poses "imminent risk of harm," or veterans not already enrolled in "services specifically tailored to veterans."

People staying in the state’s emergency shelters could be required to leave as early as September — sooner than many advocates thought. The new law turns out to be retroactive, state officials told WBUR. That means the clock started ticking for shelter residents back when they first arrived in the shelters.

Some 7,500 families are now living in the state’s emergency shelter system, a mix of traditional shelters and converted hotels. As of June 1, if they’ve been there for nine months, they could be given a 90-day notice that it’s time to leave, according to the state's Office of Housing and Livable Communities.

Some advocates say the new cap could lead some families into homelessness or precarious situations.

"Three months is not enough time," said Liz Alfred, an attorney with Greater Boston Legal Services who represents people in shelters.

"It really feels like it's going to throw people into chaos to be told, 'Sometime over the summer: you have to find someplace, any place, to go, or you're going to be on the street.' "

Under a number of circumstances, the state is allowing families to apply for up to two 90-day extensions. Eligibility covers people who are working or are in job training; those with kids in public schools; those pregnant or recently recently having given birth; and people facing imminent risk of domestic violence, among other situations.

"You're going to have a lot of people now going back again to the emergency rooms at those hospitals that we have seen play out for the past year," said Dieufort Fleurissaint, a pastor and executive director of the nonprofit True Alliance Center.

Officials are planning to stagger the shelter departures so no more than 150 families will be affected in any given week. The first departures will happen by Sept. 1 at the earliest.

- See the full WBUR stories on the shelter time limit and limit is retroactive.

Families in the Massachusetts shelter system are up against a clock. For the first time in the program's 40-year history, state lawmakers have placed a nine-month limit on shelter stays. Some families could be forced out of the shelters by September, even if they have nowhere else to go.

State leaders, including Gov. Maura Healey, say the new time limit will ease pressure on a system bursting at the seams and on track to cost taxpayers nearly $1 billion this fiscal year. But advocates for people experiencing homelessness are worried because it often takes much longer than nine months for families to leave shelters. The current average stay is 16 months, according to the state's Executive Office of Housing and Livable Communities, which oversees the family shelter system.

Ericka Guerrero and her toddler son, Leudi, entered the shelter system in late 2022. The Brookline shelter where they've been living is the only home Leudi has ever known.

The need to make space for waitlisted families was one reason behind the new time limit. The deadline isn't ironclad. Families can qualify for up to six additional months if they meet certain criteria, including being employed, in a job training program or pregnant. Still, the obstacles Guerrero has had to surmount shed light on why some families may struggle to meet the deadline.

The first big hurdle: work authorization

Guerrero came to Massachusetts from the Dominican Republic four years ago to visit family, she said. When she got pregnant, she married the baby’s father, who is a U.S. citizen. This allowed her to apply for a green card. But money troubles strained the relationship, and with the baby coming, Guerrero said, her relatives didn't have enough space for them. So, after Leudi's birth, she moved right from the hospital into the shelter.

Guerrero wanted — and needed — a job to support herself and her son. But first, she had to get a work permit from the federal government. That's one of the big hurdles for new immigrants, who make up about half of the families in the state shelter system. Obtaining work authorization can take many months.

For Guerrero, the process took almost a year: six months to get an appointment with an attorney at a free legal assistance organization and five months to get the permit itself. She now works as a hotel housekeeper.
Massachusetts and other states have pressured the federal government to expedite the work authorization process.

Since November, state officials said, they have helped more than 3,500 newly arrived immigrants apply for work authorization, and most of those permits have been approved.

Child care and housing challenges

Once Guerrero got a job, she faced another big obstacle: getting child care for Leudi. That care is expensive — about $20,000 a year, on average for infant or toddler care in Massachusetts, according to some estimates.

Guerrero applied for a voucher to help pay for it, through the state's Department of Early Education and Care. The vouchers are funded by the state and federal governments. Guerrero got the voucher in about a month, but it takes some families longer. When there's no funding available, families are placed on a waitlist, according to state officials. Families that are homeless get priority on the list.

With work and child care in place, Guerrero was finally able to search for an apartment. Affordable apartments are in short supply in Massachusetts, so there’s heavy competition when a unit opens up — another reason it often takes many months for families to leave shelters. Guerrero called this the most difficult hurdle she's had to overcome.

She applied for several different affordable units. A couple of times, she said, she was notified her application had moved to the top of a list. But that didn't mean she got the housing.

"I would be turned down, or I was rejected because I wasn't a resident of that particular town," Guerrero said. "You apply, you apply, you apply, and then you get the notification that you're almost there, and then they're like, 'Oh, sorry, you don't qualify for X reason or Y reason.' That's been the toughest part.”

According to FamilyAid, some of the reasons families get turned down for apartments include income changes after they applied, low credit scores, no credit scores for families that recently arrived in the country, utility debt or a prior eviction.

A place of their own

After all the setbacks, Guerrero recently found an apartment in Roxbury. It's subsidized through the Massachusetts Rental Voucher Program, which means she'll pay 30% of her income in rent to start, and the state will subsidize the rest. When she makes more money, she'll pay more rent.

Guerrero expected to move at the beginning of April. The date was pushed back by delays involving her rental voucher and funding from a program to help with moving expenses, according to FamilyAid. All of that has further lengthened her stay in the shelter. She hopes to finally move into her apartment this month.

State officials said they and their nonprofit partners are working to help more families get into English classes and job training, and find work, child care and housing, so they can move out of shelters. The number of families leaving shelters has steadily increased in recent months, from 197 families in December to 230 families in February and 288 in April.

However, under the state's new limit, some families could start receiving notices as soon as June 1 that they have 90 days to leave the shelters.

Larry Seamans, president and CEO of FamilyAid, said he thinks the nine-month time limit makes sense financially for the state. But he worries it will increase the risk that some families will become homeless again. He wants families’ humanity to be preserved in the push to move them out of shelter faster.

“Families don't want to live in shelter. They want to be able to raise their children like the rest of us," Seamans said.

He also expressed grave concerns about how the policy could impact children.

"Sixty-five percent of the human beating hearts living in shelters today are young children," he said. "At the center of any response, any [time] limitation has to be what they need to be successful in life, as well.”

Guerrero is dreaming of a successful life for her and her son in their soon-to-be home in Roxbury.

"A year or two from now, what I hope is that me and my son are somewhere calm, relaxed in our home [and] that I'm relaxed enough where we can just enjoy an ice cream or go to the movies," she said. "This whole experience has been like a reflection for me, where I can really appreciate the little things more."

- See the full WBUR story.

Norfolk Prison

Gov. Maura Healey is turning to a former prison in Norfolk (about 18 miles southwest of Boston) as a temporary safety net shelter for families experiencing homelessness.

The Bay State Correctional Center will help house families on the waitlist for state shelter. It was decommissioned in 2015 and remains in good condition, officials said. The state prison population has fallen by nearly half in less than a decade.

The facility can accommodate about 140 families in dorm rooms with bathrooms and showers on each floor. It also has a cafeteria, a gymnasium, a large common room, and offices that will be used for case management and administrative activities.

“The site will be set up with play areas for children, as well as classroom spaces for adults to engage in activities that support pathways to stability such as [English for Speakers of Other Languages] classes, job training courses, and housing search workshops,” Emergency Assistance
Director Scott Rice said in a statement.
The site should be up and running by next month, according to the state. The razor wire on the fence surrounding the facility will be removed and the gates will remain open so families will be free to exit and return as needed.
The shelter will house up to 140 families –- or 450 people in total deemed eligible for emergency assistance, officials said. Some of the families have been staying at Logan International Airport.

The shelter is expected to operate from six months to a year, officials said.

National Guard Armory in Lexington

A National Guard armory in Lexington will be converted into a temporary shelter for families, including immigrants, who qualify for emergency housing, according to Governor Maura Healey’s administration.

The site will be renovated to provide shelter for 55 homeless families, according to the state’s executive office of Housing and Livable Communities. By opening the site, the state will be able to move families from the Melnea A. Cass Recreational Complex, an overflow facility in Roxbury that is scheduled to close by the end of May.

“We have identified a state-owned building in Lexington to use as a safety-net site for families experiencing homelessness,” Emergency Assistance Director Scott Rice said in a statement.
Rice said the state expects the armory building to open in May. The shelter will be reserved for migrants and other homeless families, state officials said.

National Guard operations will continue at the armory, state officials said.

The health department will provide on-site assistance as requested by the state, and the public schools will help children enter the system, according to Miller.

Chelsea Soldiers Home to House Overflow Shelter

The administration also announced Monday that it will be opening a new overflow site in the next month at the former Chelsea Soldiers' Home facility, which is currently vacant and slated to be demolished.

At full capacity, it will be able to accommodate about 100 families, according to Healey's team. Services will be available on site, including assistance with applying for work authorizations, connecting with employers, and finding stable housing.

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.

"We're grateful the administration continues to look for overflow spaces for families on the waiting list. Many of the families who haven't been offered a spot in the overflow sites continue to stay in places not meant for human habitation, like Logan Airport, emergency rooms, or in cars. So it really is critical," said Kelly Turley of the Massachusetts Coalition for the Homeless.

There are currently 105 families being housed at the Roxbury center, according to Healey spokesperson Karissa Hand. The Registry of Deeds building in East Cambridge is accommodating 60 families. Eastern Nazarene College in Quincy and a location in Revere are accommodating high priority families with health conditions and being used as a safety-net site, with 22 in Quincy and 53 in Revere.

- Sources and for more information

• WBUR’s Norfolk shelter story
• The Boston Globe’s Lexington National Guard armory article.
• WBUR’s coverage that includes Chelsea Soldier’s Home changes

Between July 2023 and March 2024, about 1 in 2 calls trying to reach a SNAP worker on the DTA statewide Assistance Line (877-382-2363) were automatically disconnected due to high call volume (see DTA’s monthly scorecards). 

Note: If you recently applied or are getting SNAP, enter your information after selecting your language. If DTA needs to talk to you this may help you get through more quickly. 

What to do in this situation:

• Check if DTAConnect can help - report changes, see notices, get updates, and more. DTA may be able to automatically increase SNAP if you use DTAConnect to report an increase in rent, dependent care, or medical costs.
• Learn more about how to set up an account and report certain changes: DTA Connect for Non-Partners 2024 Final.pdf - Google Drive

• If you are 60 or older:  Call the DTA Senior Assistance Office at (833) 712-8027. Leave a voicemail if wait times are too long. 

• Go to a DTA office during business hours.  Local office information is here. 
• If DTA turns you away or you don’t get the help you need, contact MLRI at info@masslegalservices.org.  

• Try to call your local DTA office. DTA local office phone numbers are here. 

• Call the DTA Ombuds: Call 617-348-5354 and leave a voicemail.

• Call your State Representative or State Senator and ask for help getting your case fixed. Find your Rep and Senator here. You can ask for help from constituent services. This could also help support increased resources for DTA! 

Advocacy Tips:

• Document all attempted calls: This could be important to show a delay was not your fault! 

• File an appeal to ask for a fair hearing: If you think DTA incorrectly denied, reduced, or terminated (cut-off) your SNAP, you have a right to request a fair hearing. If you file the appeal request before the date the termination or reduction goes into effect - unless your SNAP is cut off after a SNAP Recertification - your SNAP benefits should continue at the amount they were at when you filed the appeal, until the appeal is decided. Here is more information on filing an appeal.

• Contact a DTA outreach partner to get help reaching DTA.  

If you get TAFDC/EAEDC: Call your assigned case worker directly (their name and phone number is on your DTA notices and DTAConnect). If you can’t reach them, call the local office. If you still don’t get help, call the Ombuds at 617-348-5354 and leave a voicemail.
Compiled by the Mass Law Reform Institute. Updated April 24,2024, 2024

Advocacy Tips: Reaching a DTA worker - Google Docs

Rental Subsidy Policy

The Social Security Administration recently published a final rule, “Expansion of the Rental Subsidy Policy for Supplemental Security Income (SSI) Applicants and Recipients.”

Under the final rule, beginning September 30, 2024, the agency will expand its SSI rental subsidy policy, which due to judicial decisions is currently only in place for SSI applicants and recipients residing in seven states (Connecticut, Illinois, Indiana, New York, Texas, Vermont, and Wisconsin). In those states, rental assistance, such as renting at a discounted rate, was less likely to affect a person’s SSI eligibility or payment amount. This new rule extends the same advantageous policy to all SSI applicants and recipients nationwide. This may increase the benefit amount some people are eligible to receive and will allow more people to qualify for critical SSI payments.

- See the SSA Press Release

Definition of Public Assistance Household

The Social Security Administration also recently published a final rule, “Expand the Definition of a Public Assistance Household.”

Under the final rule, beginning September 30, 2024, the agency will expand the definition of a public assistance household to include households receiving Supplemental Nutrition Assistance Program (SNAP) payments and households where not all members receive public assistance. The expanded definition will allow more people to qualify for SSI, increase some SSI recipients’ payment amounts, and reduce reporting burdens for individuals living in public assistance households.

The revised rule also changes the definition of a public assistance household when determining who in a household receives public assistance. The new rule defines a public assistance household as one that has both an SSI applicant or recipient, and at least one other household member who receives one or more of the listed means-tested public income-maintenance (PIM) payments (the any other definition). The previous policy required all household members to receive public assistance. This change benefits SSI recipients living in households where only some members receive public assistance.

SNAP is the first PIM benefit added to the agency’s public assistance household definition since it was established in 1980. This change helps ensure the agency’s policies better represent the current landscape of means-tested programs in the United States.

These changes are key because, if an applicant or recipient is determined to be living in a public assistance household, the agency assumes they are not receiving assistance from other household members that would otherwise be counted as income. This will allow more people to qualify for SSI and in some cases, receive a higher SSI payment.

- See the full SSA blog post.

This month, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), finalized a rule that prohibits discrimination on the basis of disability. This rule, titled Discrimination on the Basis of Disability in Health and Human Service Programs or Activities, advances equity and bolsters protections for people with disabilities under Section 504 of the Rehabilitation Act (Section 504).

Reflecting over fifty years of advocacy by the disability community, the Section 504 Final Rule clarifies and strengthens civil rights protections for people with disabilities, addresses discrimination in medical treatment, adds enforceable standards for accessible medical diagnostic equipment, and ensures accessible web content and mobile apps. The rule advances the promise of the Rehabilitation Act and helps protect people with disabilities from experiencing discrimination in any program or activity receiving funding from HHS because of their disability.

“Today’s rule is long overdue. My office heard from thousands in overwhelming support of this rule and the need to update this rule now for people with disabilities,” said HHS OCR Director Melanie Fontes Rainer. “By removing barriers to health care and social services, this rule advances justice for people with disabilities who have for too long been subject to discrimination. No diagnosis should be missed because of an inaccessible mammogram, no patient should be left with questions about test results due to inaccessible websites, and no life should be valued less due to disability.

HHS has updated the regulations to clarify obligations in several critical areas. Specifically, the rule:

• Ensures that medical treatment decisions are not based on negative biases or stereotypes about individuals with disabilities, judgments that an individual with a disability will be a burden on others, or dehumanizing beliefs that the life of an individual with a disability has less value than the life of a person without a disability.
• Prohibits the use of any measure, assessment, or tool that discounts the value of a life extension on the basis of disability to deny, limit, or otherwise condition access to an aid, benefit or service.
• Defines what accessibility means for websites and mobile applications and sets forth a specific technical standard to ensure that health care and human service activities delivered through these platforms are readily accessible to and usable by individuals with disabilities.
• Adopts the U.S. Access Board’s standards for accessible medical diagnostic equipment, like exam tables and mammography machines. The final rule also requires that, within two years of the effective date, recipients using examination tables and/or weight scales have at least one accessible version of the equipment.
• Details requirements to ensure nondiscrimination in the services provided by HHS-funded child welfare agencies, including, but not limited to, reasonable efforts to prevent foster care placement, parent-child visitation, reunification services, child placement, parenting skills programs, and in- and out-of-home services.
• Clarifies obligations to provide services in the most integrated setting, like receiving services in one's own home, appropriate to the needs of individuals with disabilities.

This rule takes effect 60 days after publication. The current rule remains in effect until that time.

A fact sheet on the rule is available here: https://www.hhs.gov/civil-rights/for-individuals/disability/section-504-rehabilitation-act-of-1973/part-84-final-rule-fact-sheet/index.html

- See the full HHS press release.

There’s a quiet sea change underway in some mental health care settings in Massachusetts and beyond — and it often looks a lot different than therapy.
People who’ve struggled with bipolar disorder, depression, anxiety and other conditions are joining the mental health workforce to support patients experiencing some of the same difficulties they've worked to cope with or overcome.

Their titles vary but include “certified peer specialist” and “young adult peer mentor.” They work alongside therapists and others, sometimes in offices with comfy chairs and white noise machines. But their goals often emphasize building connections over clinical work.

A youth treatment team at Riverside Community Care Center in Milford includes clinical social workers and psychiatrists. Riverside is one of about 30 community behavioral health centers in Massachusetts that provide a range of mental and behavioral health care services. Many of the centers have employed peer specialists for a decade or more, and they’re now adding more under a mental health “Roadmap” Massachusetts launched in 2023. The initiative aims to improve access to mental health care, recruit more industry professionals and encourage wider use of nonconventional staff like peer specialists.

“These roles are game changers entirely,” said Brooke Doyle, commissioner at the state’s Department of Mental Health.

Doyle said young adult peer mentors could play a critical role as more and more teens and young adults grapple with mental health challenges. Doyle said she’s been impressed by how peer workers initiate therapy through fun activities like sidewalk chalk drawing or video games, and eventually connect clients to other support teammates.

“Using non-traditional ways,” said Doyle, “really is the bridge to those other services.”
But bringing peer specialists onto the clinical team doesn’t work if they are isolated or their input on clinical decisions isn’t respected, Doyle said. Vic DiGravio, the president at Riverside said he’s seeing some of those tensions play out as Riverside integrates more peer specialists into care teams.

“It is still a work in progress, because it is a culture shift,” DiGravio said. “But even with that, it’s impossible to underscore how innovative and transformative this has been in 14 months and the potential for transforming the system moving forward.”

According to the Kiva Centers, a training program for certified peer specialists, there are currently more than 600 young adult peer mentors in Massachusetts. The workers take training courses that run about two weeks depending on their speciality and must pass a test to receive certification.

In the mental health field, there are unique roles for family partners and older adult peer specialists in addition to young adult peer mentors. Peer workers known as recovery coaches work many areas of addiction treatment.

While peer specialists won’t fix the broader shortage of mental health workers, they expand options for patients and providers, said Amie Sica, Riverside’s director of recovery and peer services. Some young people at Riverside might spend a lot of their time with a young adult peer mentor. Other treatment plans will be more focused on psychiatry or sessions with a social worker.

This works, Sica said, because the state’s Medicaid program gives community behavioral health centers a lump sum payment for mental health care and lets the centers decide how to spend it.
“The bundled rate gives us a lot more flexibility to meet the individualized needs of every single person who works through our doors,” Sica said.

The state’s largest private insurers have not set up a similar arrangement with community behavioral health centers, so patients with private insurance do not typically have access to all the options, including young adult peer mentors, that Nathaniel receives.

That’s one way Massachusetts is behind some other states, said Dr. Ken Duckworth, chief medical officer with the National Alliance on Mental Illness. He would like to see support for peer specialists grow quickly.

“There’s no big effort to create more psychiatrists, psychologists and social workers,” said Duckworth. “So the opportunity is for peer support to become a material part of the equation for what helps people get better.”

- See the full WBUR story.

With a limited amount of allotted time and a pressing health matter to discuss, a trip to the doctor’s office can sometimes feel like a high-stakes event. Even the most routine visits can leave you feeling dissatisfied if there’s a communication barrier, too many items on the agenda, or a personality clash.
Research shows that people who are able to vocalize their medical needs tend to be happier with their health care experiences and are even more likely to see improvements in symptoms and other important outcomes. So how can patients become better advocates for themselves and help take charge of their health in the process? We asked physicians for their best tips and strategic advice to help ensure your next doctor’s appointment goes as smoothly as possible.

Write down your concerns before the visit 

Dr. Michael Albert, chief of internal medicine with Johns Hopkins Community Physicians in Odenton, Md., says he understands what patients can be up against when they go to see their doctor. First, there’s the inherent power balance between doctor and patient, which he says is slowly changing as medical schools begin to focus more on patient-centered care, but remains a problem.

Some of that disconnect comes down to time pressures, which can make physicians feel rushed to find a “fix” for their patients, rather than validating their feelings, Albert says. To counteract that, he advises all patients to write a list of their concerns in order of urgency to help ensure that their voice is heard in the appointment. It doesn’t need to be an exhaustive narrative; in fact, being brief is key to keeping the appointment on track. But people who come prepared with a note highlighting main points they want to discuss often make better use of their limited time with the doctor. “Then we can really dig into the things that are most important,” he says.

Send a portal message the day before

When a concise written list won’t suffice—such as when a patient wants to provide contextual information about a complicated injury—Albert says sending an electronic message through a patient portal the day before an appointment can help prepare the doctor. Some insurance plans have begun paying doctors for responding to portal messages, which incentivizes doctors to communicate with patients.

Just don’t expect doctors to respond to complex questions through portal communication, Albert says. Those issues are best addressed in person.

Google your symptoms—yes, really

Doctors rarely advise patients to fall down a rabbit hole online. But that doesn’t mean you shouldn’t do research. The best patient is the informed patient, according to Dr. Benita Petri-Pickstone, a family physician in Gahanna, Ohio and clinical assistant professor of family and community medicine at the Ohio State University Wexner Medical Center in Columbus. She says a vital aspect of self-advocacy is for patients to take an active role in their health, which means doing their research ahead of time so they can ask informed questions. Be proactive, raise any concerns with your doctor, and don’t hesitate to ask a multitude of questions, she says.

“The patient who tends to get the better care is usually one that is more vocal and asks informed questions about things based on what they’ve read and based on symptoms that they are feeling,” Petri-Pickstone says.

Bring someone to your appointment

In situations where people may not be able to advocate for themselves, such as seniors who are experiencing a cognitive decline, Petri-Pickstone encourages them to bring along a trusted friend or family member. “I’m always open to having spouses and children come in with the patient to help give a good history so I can find out the total picture about what’s happening,” she says. 

Seek a second opinion
When patients are experiencing doubt or appear to be uneasy, Mills encourages them to seek a second opinion. Mills often sees patients who are coming to her for one,  and she believes it’s a critical step people can take to advocate for themselves and ensure they are getting the right care. 

She says that sometimes, patients don’t want to tell her they are in her office to seek a second opinion because they’re afraid it will color her opinion. But Mills says she believes it better serves patients if they are transparent and speak about the specific concerns that prompted them to seek the advice of another physician. “It sets the stage in a different way,” she says.

Don’t hesitate to find new care

Sometimes, the relationship between a doctor and patient just isn’t the right fit, Albert says. If someone has tried everything and the doctor is impossible to understand or just doesn’t listen, it might be time to seek another provider, he says. “They should select somebody who they feel more comfortable with,” he says.

The ideal doctor-patient relationship will vary depending on a person’s needs. But in general, people should be able to have a back-and-forth discussion with their physician and feel like their concerns are being heard and addressed, Albert says. If people feel like their doctor is going to listen, it becomes much easier for them to advocate for what they need.

- See the full TIME magazine article.

The Department of Children and Families is ending a controversial practice that diverted to the state millions in federal Social Security benefits meant for foster children.

In recent years, DCF withheld about $5.5 million annually, or roughly 90 percent of the survivor and disability benefits intended for foster children who lost a parent or have a disability, and instead redirected the money to the state’s general treasury.

The practice, which affected about 600 youth annually, was legal but controversial, with child advocates calling it exploitative; it amounted to making children pay for their own care, advocates said.

“It wasn’t really adding anything significant to our state budget,” said Rachel Gwaltney, executive director of Children’s League of Massachusetts, “and it was taking away money that really rightfully belonged to these young people.”

As of Jan. 1, DCF stopped withholding survivor benefits of foster children, a DCF spokesperson said. The money held by DCF will be returned to the Social Security Administration, and recipients can request it from the federal agency once they leave foster care. The agency is also in the process of phasing out the practice of keeping disability benefits. Those funds are now being placed into personal accounts that allow people with disabilities to build savings while still receiving supplemental assistance such as Social Security or Medicaid. The agency expected to have all 311 of those accounts established through Fidelity Investments and operating in a matter of weeks.

”Conserving, rather than diverting, almost $6 million dollars a year in Social Security benefits will help stabilize the lives of so many youth with disabilities in foster care, transitioning into adulthood,“ said Rick Glassman, director of advocacy at the Disability Law Center, which had lobbied DCF and the Legislature to change the practice.

Both survivors and disability benefits will be available to foster children either when they age out of the system or return to their families.

The practice of using children’s Social Security benefits to patch state budgets has come under increasing criticism in recent years, Gwaltney said. The Marshall Project and NPR drew attention to the issue in 2021, reporting that state child protection agencies nationwide collected, in 2018 alone, more than $165 million in Social Security benefits for children in their care. Last year, a Boston Globe story on legislation to end the practice in Massachusetts

State Senator Joanne Comerford, a Democrat from Northampton and sponsor of the legislation, is still pushing for passage of her bill to ensure Massachusetts doesn’t try to reclaim the funds again but applauded the DCF announcement that it was ending the practice.

Prior to this year, foster children in Massachusetts could only have up to $2,000, including money from Social Security payments, in personal need accounts. Anything in excess of that went to the state’s general fund. That money was not directly allocated to fund DCF’s more than $1 billion budget, though the agency had said it indirectly helped cover the costs of a child’s care.

The practice could be financially devastating, though, for children and families. Social Security funds can be a critical source of stability for young adults who are just exiting the foster system, Gwaltney said.

“It certainly gives them a base from which to do all the things that young people going off on their own need to do,” she said.

A DCF spokesperson said anyone who believes the agency is still holding Social Security funds should contact the department’s Ombudsman’s Office.

- See the full Boston Globe article.

Last June allegations surfaced that the morgue manager at Harvard University's medical school had been dismembering donated bodies, and stealing and selling their parts — all seemingly without raising suspicion from anyone at the Ivy League institution.

WBUR reporter Ally Jarmanning covered the story, and she delved deeper into what happened at Harvard and some of the questions it raised in the latest season of WBUR's podcast Last Seen, called "Postmortem."

In the aftermath of that disturbing development, here are some things to know before donating your body to science.

Medical schools still need real bodies

Although technology continues to get better, it seems mannequins and virtual programs just don’t cut it.

One reason for this is each individual is just a little different from the next. I find this somewhat comforting — we really are unique!

And so far, doctors told Ally, there’s no real substitute for practicing on a human body.

“We want our surgeons to know what it’s like to cut through skin, fat and muscle, and navigate our ligaments and tendons — before they do it on a living patient,” Ally said.

Working with the dead can provide lessons about the living

This may be the most important reason to use a human body from a donor. Beyond anatomy, it teaches people how to treat the living.

“Many medical schools call donor bodies students’ ‘first patient’ or ‘silent mentor,’ " Ally said. “Most programs now expect students to treat the body donor like they would a patient. They insist on practices like only uncovering the part of the body the students are working on.”

It’s hard to evaluate the quality of body donor programs

First, Ally recommends talking to the people in charge, and asking detailed questions about how they operate: Do the donor bodies stay with the school, or are they loaned or sent out to other facilities? Will the bodies be used solely for student learning or are they used for other research, too?

Second, Ally recommends reviewing any forms the program asks donors to sign. Look out for specific information they provide about how a body can be used and what the program will do. Are there clear descriptions? Does the form limit how the body will be used, or does it give the business or medical school broad latitude?

There’s little oversight of this industry

There are few rules and regulations governing donated body programs, Ally told me. For example, in Massachusetts, no one is tasked with inspecting medical school morgues, and the state doesn’t oversee these programs.

“Each school is making its own rules and standards,” Ally said. “Sometimes, it’s even up to the individual anatomy professor to create ethical standards.

The bottom line is there's a wide range in how different programs and individuals define what is acceptable. And it doesn't get much better at the federal level.

“There's much better tracing for a head of lettuce than there is for a human head,” FBI agent Paul Micah Johnson told Ally.

Johnson is an expert in body broker cases, and he explained that the government can track a head of lettuce all the way back to the farm where it was grown, including where it stopped on its way to the supermarket. “Not so, for a human body,” Ally said. “There’s no registry, no national database, no rules or regulations.”

Companies and institutions like medical schools have a lot of freedom to use donated bodies the way they want, as long as no body parts are being transplanted into a living person, Ally said. This was one of the most surprising things she learned while doing this reporting.

- See the full WBUR story.

The Neighborhood Developer’s Housing Assistance Hotline staff supports Chelsea households at risk of becoming homeless, experiencing a housing crisis, or facing eviction. We partner with Metro Housing|Boston and La Colaborativa to bring you essential resources to secure and keep your housing.

Core services

We can help you stay in your home by providing:

• Education on types of rental assistance that you and your household may qualify for, such as RAFT
• Assistance applying for state-wide programs that provide emergency housing assistance to cover past-due rent, moving fees, and other housing costs
• Education on your rights as a tenant
• Advocacy with landlords
• Referrals to legal aid and other housing advocacy groups and services

Chelsea residents can call 617-712-3487 to speak to a CONNECT hotline specialist.

If you reach their voicemail, please leave a message; messages are returned within an average of one-two business days. Alternatively, complete their online intake form and they will reply within three business days.

Advocates (only) should refer using this partner referral form, which allows for more information sharing and easier triage. 

- Thanks to Lauren DeMarco for sharing this resource and Kavish Gandhi, Housing Assistance Hotline Manager, for assistance with the article.

People who have been incarcerated face numerous challenges when they return to society, especially when it comes to getting a job and finding a place to live. Sometimes a few thousand dollars can make all the difference, providing a way to buy a car to get to work or put down a security deposit on an apartment. But with a criminal record and no recent employment or credit history, many lenders won’t approve funding, or will only grant it with a sky-high interest rate.

A nonprofit being launched in Boston in July, with help from an investment by the GreenLight Fund, aims to fill this need by offering low-interest loans of up to $15,000, along with financial planning and community support, for formerly incarcerated residents. Boston will be the fifth market for the Fountain Fund, which was founded in 2017 in Charlottesville, Va., and has issued 500 loans — typically for a three-year term with 5 percent interest — totaling more than $2.25 million.

Applicants with any type of conviction are eligible, but they must have a job that will allow them to pay back the loan and show that the funds will provide a “potential elevation in their personal circumstances,” such as paying off a debt, getting their car insured, or starting a business.

The Fountain Fund staff reviews applicants closely, examining their income and monthly bills before presenting cases to a loan review committee made up of formerly incarcerated people and community leaders, said Jay Vilar, the former program director at Haley House in Boston, who was just named director of the local Fountain Fund. The money is paid directly to landlords, car dealerships, and other vendors, said Vilar, 45, who lives in Roxbury and has an older brother who has been in and out of prison. The nonprofit also partners with community organizations that provide financial literacy training for loan recipients, each of whom must complete an FDIC financial education course online.

Many of those who have served time can’t rely on relatives for financial help, said Kristine McDonald, a Brockton attorney who works with people returning from incarceration through the Massachusetts Communities Action Network, a network of faith-based leaders and community organizers dedicated to economic justice and racial equity.

“This is a demographic that has been denied generational wealth,” she said. “All of the economic injustices that have been perpetuated for generations and generations of Black and brown people are very much at play.”

When Dormen Lisby first tried to buy a car after serving 26 years in prison in Pennsylvania, the dealership would only offer him financing with a 25 percent interest rate. So Lisby, who lives in Philadelphia, turned to the Fountain Fund, which gave him a $13,000 loan — with 3 percent interest — to buy a 2014 Nissan Maxima.

Lisby, 52, uses the car to get to work as a program specialist for Shining Light, a nonprofit that provides re-entry programming inside prisons, and take his mother to the hospital for cancer treatments. He also uses it as a “tool of wellness,” rolling down the windows, cranking up the stereo, and going wherever he pleases.

“To be able to drive,” he said, “is the ultimate expression of freedom.”

- See the full Boston Globe article.

There is a safe and trusted way to find out if you may be eligible for benefits programs, including the most commonly missed benefits, such as SNAP, and the Medicare D Low-Income Subsidy. It’s called BenefitsCheckUp®. The National Council on Aging (NCOA) offers this free, easy-to-use tool that features more than 2,000 public and private benefits programs available in all 50 states and the District of Columbia. Visitors enter confidential information while remaining anonymous. They instantly get a report of programs they may be eligible for—plus next steps on how to apply. 

- See the full SSA Blog post.

The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), finalized a rule that will expand access to health care for Deferred Action for Childhood Arrivals (DACA) recipients. Today’s rule ensures DACA recipients will no longer be excluded from eligibility to enroll in a Qualified Health Plan (QHP) through the Affordable Care Act (ACA) Health Insurance Marketplace. CMS estimates that this rule could lead to 100,000 previously uninsured DACA recipients enrolling in health coverage through Marketplaces or a BHP.  

As a result of this rule, DACA recipients and other newly eligible individuals will qualify for a special enrollment period to select a health plan through the Marketplace during the 60 days following the rule’s November 1, 2024, effective date.

Newly eligible individuals, including DACA recipients, will qualify for a special enrollment period to enroll in a QHP through the Marketplace during the 60 days following November 1, 2024. Consumers who apply for coverage through a SEP during November 2024 can have their Marketplace coverage begin as early as December 1, 2024, if they meet all other eligibility requirements. Consumers who apply for coverage through a SEP during December 2024 can have their Marketplace coverage begin as early as January 1, 2025, if they meet all other eligibility requirements. Finally, consumers who apply for coverage in January 2025 through the individual market Open Enrollment Period can have their coverage begin February 1, 2025, or March 1, 2025, depending on when they apply and their state’s rules.

“HHS is committed to making health coverage accessible for people DACA recipients – Dreamers – who have worked hard to live the American Dream. Dreamers are our neighbors and friends; they are students, teachers, social workers, doctors, and nurses. More importantly, they are fellow Americans,” said HHS Secretary Xavier Becerra. “More than one third of DACA recipients currently do not have health insurance, so making them eligible to enroll in coverage will improve their health and wellbeing, and help the overall economy.”  

For more information on the final rule, see the fact sheet at https://www.cms.gov/newsroom/fact-sheets/hhs-final-rule-clarifying-eligibility-deferred-action-childhood-arrivals-daca-recipients-and-certain.

- See the full CMS press release and fact sheet.

Last year, Massachusetts established a $192 million behavioral health trust fund that supports an array of incentives to attract and retain workers in behavioral health fields, including scholarships, loan repayment programs, and compensation for unpaid internships. But despite an urgent need to counter a serious behavioral health labor shortage in the state, the money has almost entirely stayed in the hands of the Executive Office of Health and Human Services.

HHS officials say some of the money, about $75.8 million, will start flowing this fall, including $25 million for scholarships, $25 million in stipends for student field work or internships, and $3 million to cover behavioral health licensure fees through the Department of Public Health.

But more than half of funds, $100 million, are for a loan repayment program that’s highly anticipated in an industry struggling to retain workers. In the fall, the state will begin taking applications, but that money won’t begin to reach loan servicers until March 2025, at the soonest, HHS reported. HHS originally planned to distribute the money in December 2025, said several officials with knowledge of the program. The agency moved up its date last month after receiving pressure from several senators, they said.

“There’s a behavioral health workforce crisis and we need those funds,” said Rebekah Gewirtz, executive director of the National Association of Social Workers chapters in Massachusetts and Rhode Island.

The health care industry as a whole is struggling with a workforce shortage but the lack of behavioral health workers has proven to be especially hard to address. More than a quarter of licensed clinician positions in behavioral health are unfilled, according to a study released this week by the state’s Center for Health Information and Analysis. Close to 1,500 patients each day wait in the state’s hospitals, sometimes for months, for care, because there are not enough workers to staff licensed inpatient psychiatric beds, according to a May report from the Massachusetts Health and Hospital Association.

- See the full Boston Globe article.

The Senate’s budget proposal for the coming fiscal year calls for directing $214 million to the state’s 15 regional transit authorities, including $40 million so they can eliminate fares on all of their bus routes and $10 million to promote routes connecting regions.

It’s a bold plan, one that has been hailed as a big step forward for transit agencies that have historically lived in the shadow of the much larger MBTA. Senate leaders say the money is also a step toward greater equity in transportation.

A new report portrays the RTAs as largely inward-looking organizations that lack connection with each other and are subject to muddled oversight from the state Department of Transportation. The result is a somewhat disjointed overall transit system that sometimes struggles to get people where they need to go and is over-reliant on funding from the communities being served.

The report was commissioned by the town of Ware and the Quaboag Connector, a rural micro-transit service backed by the Quaboag Valley Community Development Corporation. It was paid for with grant funds from the Health Foundation of Central Massachusetts. The analysis contained in the report was developed by the Center for Policy Analysis at Tufts University.

The report raises concerns about inadequate funding and oversight of the RTAs, placing a good chunk of the blame on the Department of Transportation, which parcels out the money.

“The current approach to regional transit funding is not built on a clear set of publicly shared principles,” the report says. “Funding levels in any given year seem to reflect funding levels the year before—which were themselves correlated with funding levels the year before that. Absent an explicit formula for RTAs, the de facto effect of this funding-by-inertia approach is that funding levels mostly reflect ridership, with no obvious adjustments for need, capacity, or otherwise.”

The report also found that the “funding-by-inertia” approach fails to adequately address income disparities between the RTAs. Lower-income regions receive some extra aid, the report says, but overall “the effect is somewhat arbitrary and highly variable, favoring select low-income regions over others (the Southeastern RTA is relatively underfunded, given its income level, while the Pioneer Valley RTA is generously funded).”

Evan Horowitz, the executive director of the Center for State Policy Analysis, said he had difficulty obtaining guiding principles on funding decisions from the Massachusetts Department of Transportation, even after filing public records requests for documents.

Service levels vary widely among the RTAs. Most offer bus service within their territories, but some only offer paratransit service or rides for seniors. Some towns within the RTA service areas don’t participate at all.

The Merrimack Valley Regional Transit Authority is at the forefront of RTAs experimenting with new approaches and services. Noah Berger, executive director, said the authority went fully fare free in March 2022. He said ridership is 60 percent above pre-pandemic levels.

If the Senate funding approach for RTAs prevails in budget negotiations on Beacon Hill, Berger said, he expects to receive a portion of the state money to cover his agency’s loss of revenue from eliminating fares, which would free up funding for other initiatives.

Already the RTA runs a bus route between Lawrence, which is in the transit authority’s service area, to Lowell, which is not. The RTA also offers paratransit service to a Veterans Administration facility in Bedford.

- From Are state’s 15 regional transit authorities ready for prime time?, CommonWealth Beacon, May 14, 2024.

Larry Moore, of Camden, N.J, defied the odds — he snatched his life back from a spiral of destruction. The question is: how?

For more than two years straight, Moore was sick, homeless and close-to-death drunk — on mouthwash, cologne, anything with alcohol, he says. He landed in the hospital 70 times between the fall of 2014 and the summer of 2017.

Then, in early 2018, something clicked, and turned Moore around. Today, he's more than five-years sober with his own apartment, and he has only needed the ER a handful of times since 2020. He's active in his church and building new relationships with his family.

Moore largely credits the Camden Coalition, a team of nurses, social workers and care coordinators for his transformation. The nonprofit organization seeks out health care's toughest patients — people whose medical and social problems combine to land them in the ER dozens of times a year — and wraps them in a quilt of medical care and social services. For Moore, that meant getting him medical attention, addiction treatment and — this was key for him — a permanent place to live.

"The Camden Coalition, they came and found me because I was really lost," Moore says. "They saved my life."

For two decades, hospitals, health insurers and state Medicaid programs across the country have yearned for a way to transform the health of people like Moore as reliably as a pill lowers cholesterol or an inhaler clears the lungs. In theory, regularly preventing even a few $10,000-hospital-stays a year for these costly repeat customers could both improve the health of marginalized people and save big dollars.

But breaking this expensive cycle — particularly for patients whose lives are complicated by social problems like poverty and homelessness — has proved much harder than many health care leaders had hoped. For example, a pair of influential studies published in 2020 and 2023 found that the Coalition's pioneering approach of marrying medical and social services failed to reduce either ER visits or hospital readmissions. Larry Moore is the outlier, not the rule.

"The idea that someone should go to the emergency room 100 times in a year is a sign of deep, deep system dysfunction," says Jeff Brenner, the primary care physician who founded and led the Camden Coalition from 2002 until 2017. "It should be fixable. We're clearly still struggling."

Yet, Brenner and others on the frontlines of one of health care's toughest, priciest problems say they know a lot more today about what works and what misses the mark. Here are four lessons they've learned:

Lesson 1: Each patient needs a tailored, sustained plan. Not a quick fix

The Camden Coalition originally believed that just a few months of extra medical and social support would be enough to reduce the cycle of expensive hospital readmissions. But a 2020 study published in the New England Journal of Medicine found that patients who got about 90 days of help from the Coalition were just as likely to end up back in the hospital as those who did not.
That's because, frontline organizations now realize, in some cases this wraparound approach takes more time to work than early pioneers expected.
Frontline groups have also learned their services must be more targeted, says Allison Hamblin, who heads the nonprofit Center for Health Care Strategies, which helps state Medicaid agencies implement new programs. Organizations have begun to tailor their playbooks so the person with uncontrolled schizophrenia and the person battling addiction receive different sets of services.

Aaron Truchil, the Coalition's senior analytics director, likens this shift in treatment to the evolution of cancer care, when researchers realized that what looked like one disease was actually many and each required an individualized treatment.

"We don't yet have treatments for every segment of patient," Truchil says. "But that's where the work ahead lies."

Lesson 2: Invest more in the social safety net

Another expensive truth that this field has helped highlight: America's social safety net is frayed, at best.

The Coalition's original model hinged on the theory that navigating people to existing resources like primary care clinics and shelters would be enough to improve a person's health and simultaneously drive down health spending.
Over the years, some studies have found this kind of coordination can improve people's access to medical care, but fails to stabilize their lives enough to keep them out of the hospital. One reason: People frequently admitted to the hospital often have profound, urgent needs for an array of social services that outstrip local resources.

As a result of this early work, Hamblin says, state and federal officials — and even private insurers — now see social issues like a lack of housing as health problems, and are stepping in to fix them.

Some health care experts also still question whether doctors and insurers are best positioned to lead these investments, or if policymakers and the social service sector should drive this work instead.

Lesson 3: Recent boom in new programs demands better coordination

This spike in spending has led to a wave of new organizations clamoring to serve this small but complex population, which Hamblin says can create waste in the system and confusion for patients.

"All of these barriers to entry and handoffs don't work for traumatized people," former Coalition CEO Brenner says. "They're now having to form new, trusting relationships with multiple different groups of people."

Streamlining more services under a single organization's roof is one possible solution.

Lesson 4: Rethink your definition of success, and keep going

Twenty years ago, the goal of the Camden Coalition was to help their medically complex patients stay out of the E.R. and out of the hospital — provide better health care for less cost. Noonan, who took over from Jeff Brenner as CEO of the Coalition, says they've made progress in providing better care, at least in some cases — and that's a success. Saving money has been tougher.

"We certainly don't have quick dollars to save," Noonan says. "We still believe that there's tons of waste and use of the [E.R.] that could be reduced ... but it's going to take a lot longer."

Still, she and others in her field do see a path forward. As they focus on improving their patients' mental and physical health by developing and delivering the right mix of interventions in "the right dose," they believe the cost savings may ultimately follow, as they did in Larry Moore's case.

The stakes are high. Today, homelessness and addiction combined cost the U.S. health care system north of $20 billion a year, wreaking havoc on millions of Americans. As health care delivery has evolved in the last two decades, the question is no longer whether to address people's social needs, but how best to do that.

- See the full NPR story.

Most agree that Massachusetts is on the precipice of a public health emergency. Workforce shortages combined with an uncertain future for eight hospitals in the Commonwealth threaten to push our capacity crisis over the edge.

Discussions about stretched and overcrowded hospitals tend to focus on limited availability in post-acute rehabilitative or skilled nursing facilities. This leads to logjams in emergency rooms and inpatient units. Home health providers play an equally important role in alleviating these pressures, yet our challenges too often go unnoticed.

Home health organizations are trained to evaluate patients’ homes for safety and special accommodations. Their care substantially reduces hospital readmissions, which creates better health outcomes, eases strain on hospitals, and reduces costs for the system as a whole.

It’s no surprise that referrals to home health organizations are skyrocketing as hospital capacities worsen. Yet we are struggling to keep up with demand. Like everyone in healthcare, home health providers contend with severe clinician shortages. But our problems are compounded by reimbursement issues that threaten our industry’s sustainability. Medicare Advantage in particular is driving this crisis.

Private insurers that offer Medicare Advantage are paid set rates by the federal government to cover healthcare services for beneficiaries who opt out of traditional Medicare. These insurance companies then negotiate with healthcare providers, like visiting nurse associations, over how much they reimburse the organizations caring for their members. More than half of eligible Medicare beneficiaries are enrolled in Medicare Advantage, and that figure is growing. 

Unfortunately, Medicare Advantage insurers reimburse home health providers at substantially lower rates than traditional Medicare for the same services. At VNA Care, the home health agency I run, the average reimbursement per traditional Medicare admission was about $3,700 last year. Medicare Advantage reimbursements, conversely, were an average of about $1,600. That is a 56 percent difference. As a result, we lost about $6.4 million serving a higher-than-average population of Medicare Advantage patients. This leads to an unsustainable loss of about 11 percent per year taking care of some of the region’s most frail and elderly residents.

These losses are not unique to us. According to BerryDunn, a regional professional services firm, the average operating margin for Massachusetts home health providers in 2022 was approximately negative 6.71 percent. While inadequate Medicare Advantage reimbursements send home care providers into financial crisis, these plans actually cost the government and taxpayers about 6 percent more than traditional Medicare.

These underpayments, combined with workforce shortages, rising labor costs, and rising Medicare Advantage enrollment, create a perfect storm for home health providers. As a matter of survival, agencies including VNA Care have begun to restrict Medicare Advantage patient admissions or terminate contracts with the worst-paying Medicare Advantage insurers.

While limiting Medicare Advantage admissions may help home health providers get by, it spells disaster for our healthcare system. More and more, Medicare Advantage patients who need home care won’t have anywhere to get it. All the reimbursement and staffing challenges facing home health agencies are already affecting patient access to care. 

If the effects on patient care aren’t enough, there are financial incentives to increasing Medicare Advantage rates for home health. Home health clinicians prevent unnecessary hospitalizations and readmissions, which are far more costly for both patients and providers.

Now is the time for elected officials and public policy experts to craft solutions that will support VNAs and home health agencies. The health care capacity crisis in Massachusetts will only worsen as home health providers face such substantial losses and begin to fail. Paying home health agencies at fair and equitable rates for Medicare Advantage patients will allow us to better do our part in helping our communities, our hospital partners and – most importantly – the patients and families who rely upon us to keep them home, where they most want to be.

Todd Rose is CEO of VNA Care. 

- See the full Commonwealth Beacon opinion piece.