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MGH Community News |
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MGH Community News |
| February 2019 | Volume 23 • Issue 2 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Elena Chace, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
March SNAP Going Out a Few Days Early to the Majority of Households SNAP is typically issued between the 1st and 14th of the month. DTA is issuing SNAP a few days early to close the gap between the early February issuance due to the Government shutdown and the regular March issuance. DTA will be doing robocalls to all households telling them about what is going on. Here are updated fliers from MLRI, the Food Banks, and Project Bread in English and Spanish. This change will affect the majority of households. Some households will get their SNAP on their normal issuance date - for example, if they usually get their SNAP the first couple of days in the month, or if they recently had to do paperwork to keep SNAP. Issuance will return to normal in April for all households. DTA has updated the Q & A on their webpage. - From Update: Early March SNAP issuance, sign on letter for Puerto Rico, ABAWD comment webinar, FoodSNAP Coalition listserv, on behalf of Victoria Negus, MLRI, February 21, 2019.
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| Mass. Issues Guidelines Against Denying Life Insurance to Those Carrying Naloxone
Massachusetts is advising life and disability insurers not to deny coverage to good Samaritans who carry the overdose-reversal drug naloxone. The guidelines, issued earlier this month, follow a WBUR story in December about a Boston nurse who was denied life insurance because she carries the drug (and that was reported here last month - Why You May Be Denied Life Insurance For Carrying Naloxone). The bulletin, from the state Division of Insurance, says rejecting disability, life or long-term care insurance applicants because they carry naloxone to help others “would defeat the Commonwealth’s important public health efforts.” |
Massachusetts declared the opioid epidemic to be a public health emergency in 2014. Four years later, the state issued what's known as a standing order prescription, so residents can purchase naloxone at any pharmacy. Some public health experts who worried that the insurance denials would have a chilling effect on the use of naloxone say they are pleased with the Massachusetts bulletin. It “appears to significantly address the concerns that we were hearing regarding the use and prescribing of naloxone to family members and other good Samaritans,” said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center. The National Association of Insurance Commissioners (NAIC) had said, in response to an inquiry from U.S. Sen. Ed Markey, that the Massachusetts guidance “will provide a model other states can consider using.” In response to a comment for this story, the NAIC said it is reviewing the bulletin. The American Council of Life Insurers (ACLI) said in a statement that it supports the Massachusetts bulletin. The ACLI however has said that a prescription for naloxone may lead to additional questions about the request for coverage and the reason for the prescription, which are in keeping with evaluating an applicant's risk. Massachusetts regulators say they expect that insurance companies will get enough information to determine whether the naloxone prescription is relevant to the person's health, but that it alone should not adversely affect the evaluation. Making that determination may be difficult for some agents and could lead to unfair denials. The Massachusetts guidance also applies to applicants prescribed PrEP, the pills that prevent transmission of HIV. -See the full WBUR story.
One Hundredth Memory Café Opens in Massachusetts Jewish Family & Children’s Service (JF&CS) marked a milestone - there are now more than one hundred memory cafés in Massachusetts! Memory cafés are social gatherings for people living with Alzheimer’s or a related disorder, their family members, friends, and caregivers. When JF&CS started its monthly memory café in 2014, it was the second memory café in Massachusetts.
A memory café is a welcoming place for people with forgetfulness or other changes in their thinking and for their family and friends. Memory cafés meet at a variety of places including coffeehouses, museums, or community organizations. Soon after JF&CS opened its memory café, our guests started asking for more meeting times and locations so that they could enjoy the café atmosphere more than once a month. JF&CS responded by launching the JF&CS Percolator Memory Café Network, which assists other organizations in starting and running their cafés.
The Percolator offers a free Memory Café Toolkit, a directory to help café coordinators find guest artists to lead expressive arts activities at their café, and distributes tips and ideas so that no one has to “reinvent the wheel” when starting their café. It provides technical assistance and convenes quarterly meetings to share best practices. JF&CS also hosts a statewide Memory Café Directory, so Massachusetts residents can easily find cafés in their neighborhood. Want a sneak peek of what it is like to visit a memory café? Check out this one-minute video profiling our cafés in English and Spanish. See the: Memory Café Directory - See the full JF&CS blog post.
ACS March Program Pause – Transportation and Hotel Partners Program A version of this article was sent to MGH Oncology social workers earlier this month. The American Cancer Society (ACS) is switching to a new referral system in March which necessitates a pause in their transportation and Hotel Partners program. They will be unable to fulfill transportation and Hotel Partners requests from Friday, March 1 - Friday, March 8. Their Patient Services Center outreached to existing patients who will be impacted by the gap in services. Please note: Boston Hope Lodge is not affected; this only applies to transportation and the Hotel Partners Program. The ACS said in a statement “Cancelling the requests is necessary to prevent patients from experiencing missed rides, lodging, and appointments while new systems are launching, but we understand the significant inconvenience this is to our patients and providers.” Referrals in the system prior to 2/28 should be honored and resume on or after March 11th. Patients will still be able to contact the ACS for information and community referrals during the first week of March.
State Will Offer Dorm Rooms for Some Homeless College Students A group of 20 college students recently moved into residence halls on four public university campuses, in a push by Massachusetts officials to reduce youth homelessness. State higher education officials hope that by providing vulnerable community college and university students a secure place to live, guaranteed meals at the campus dining halls, and more support, such as mental health counseling, they will boost academic success and, ultimately, ensure that these students graduate. Massachusetts initially plans to spend $120,000 to pilot the student housing program at Bridgewater State, Framingham State, and Worcester State universities and at the University of Massachusetts Lowell, with more funding expected in the next budget. Governor Charlie Baker announced the program as part of a rollout of $3 million in grants to community organizations across the state that help homeless youth. Massachusetts officials estimate that there are between 500 to 1,000 unaccompanied homeless youth. An online survey done in 2017 at a majority of the state’s public campuses conducted by the Wisconsin HOPE Lab found that 13 percent of Massachusetts community college students reported experiencing homeless in the previous year. Many said that they did not know where they were going to sleep, even for one night, or had been thrown out of their homes. At the state’s public four-year colleges and universities, 10 percent reported being homeless in the past year, according to the survey. Homelessness was particularly acute for students who were coming out of the foster care system. Some of the students in the state’s pilot program said they have been couch-surfing, living with their families in shelters, or staying at hotels occasionally. Some of the students were kicked out of their homes in high school and have been on their own for years. Others come from families who are transient, and they may not have a place to return to when residence halls close for breaks. The state is guaranteeing the students a yearlong place to live as long as they are enrolled in school full time, are under the age of 25, and remain in good academic standing. Massachusetts is among a handful of states testing new approaches to help homeless college students, said Sara Goldrick-Rab, the founder of HOPE lab, an academic center that studies homelessness and hunger issues. Goldrick-Rab is currently a professor at Temple University. Whether the Massachusetts program can be expanded to the state’s other public university campuses remains an open question, Goldrick-Rab said. For now, the program is not available to students over 25 or those who have families. Many students attending community college are older, working adults who are also trying to support families. -See the full Boston Globe article.
New Mass. General Buildings Would Be Designed to Survive Battering from a Superstorm - or Terrorists
Massachusetts General Hospital this month filed plans for a $1-billion project that would not only provide "21st century care in a 21st century environment" but create "a place of refuge" where hospital staffers and patients could shelter for up to four days in the face of the worst nature - or man - could throw at Boston. In the plans, filed with the BPDA, New England's oldest and largest hospital details its plans to build a two-tower, 13-story building along Cambridge Street, with 456 new beds, all in single-occupancy rooms, which the hospital said would let it cater to patient demand, increase patient privacy, stay current with rivals and even reduce the chances of communicable diseases spreading. The hospital would decommission older beds in two-patient rooms elsewhere, for a net gain of about 203 new beds. The new building would also include new, more efficient surgical units and underground parking spaces. A second, seven-story building would go up to house central hospital mechanical and support services and could become home to an electrical generator. The new buildings would require razing several existing buildings; their programs would be relocated to other buildings on the MGH campus. The new clinical towers would be connected to the rest of the MGH campus by a two-level pedestrian bridge - which would be key to the hospital's plans to turn them into a redoubt in advance of or during an emergency, such as a battering storm, devastating flooding or a massive attack on the campus. The connection will also support MGH's resiliency planning by allowing for elevated movement of any patient or material to the modern place of refuge that will be the new Clinical Building. The hospital expanded on the theme: MGH recognizes that it must be able to ensure the safety of its patients, visitors and staff in a disaster, as well as to be able to provide uninterrupted healthcare services to the City as a critical facility within the community. Both Hurricanes Katrina in New Orleans and Sandy in New York have clearly demonstrated the consequences of hospital failures for those communities, and the importance of creating hospitals that can withstand damaging winds, major flooding, seismic activity and other disasters – natural or human-induced. ... The building will not just adhere to but will exceed the current emergency preparedness requirements set forth by The Joint Commission and the Centers for Medicare and Medicaid Services. ... Because much of the Main Campus sits on land in the West End that was once water and marsh, this section of the city is vulnerable to flooding and storm surge as sea levels continue to rise. As seen in recent years in the wake of Hurricane Katrina and Hurricane Sandy, the impact of flooding and winds can be devastating for hospitals, and life threatening for patients, families and staff. The approximate flood elevation at the site is 21.0' to 22.0' (Boston City Base). Based upon up-to-date climate change projections provided to MGH by climate experts at Woods Hole Oceanographic Institution and also external engineering experts who have evaluated flooding risks of the Main Campus in the setting of climate change, the Clinical Building and Campus Services Building will be designed to withstand up to six feet of flooding; this will allow the Clinical Building to serve as a place of refuge for the campus and the MGH community. The resiliency of the buildings will be designed to allow continuous operability of all critical services during a catastrophic event such as a severe nor'easter, hurricane or flood. In addition, the exterior skin and the windows of the buildings will be designed to withstand hurricane force winds. All building services that are located below the potential flood level will either be floodproofed or be designed to have the ability to recover quickly following a flood event, allowing the building to continue uninterrupted operations. The Clinical Building will be designed to play a primary role in supporting the resilience of the entire Main Campus in the event of a disaster. It will do this not just by physically protecting patients and staff who are located within the building, but also by supporting other functions across the Main Campus and sustaining patient care. Patients from vulnerable buildings can be relocated and refuge provided for staff. It is anticipated that people will be able to shelter in place for 96 hours. The new facility will be designed to allow continuous operability of all critical services during an event (and a phased emergency response plan for recovery of other services after an event). The hospital said it has also taken steps to fortify its existing buildings and systems. Among these steps: Moving critical electrical systems out of basements in case of flooding, creating a new oxygen network and installing new "oxygen manifold systems" to continue supplying the vital gas to patients and operating rooms should part of the system go down and putting special coatings on windows and doors facing outward to minimize potential damage and injuries from shrapnel in an explosion. -See the full Universal Hub article.
State offers online application for Massachusetts Global War on Terrorism Welcome Home Bonus The Office of the State Treasurer, Veterans’ Bonus Division has launched an online application for the Massachusetts Global War on Terrorism (GWOT) Welcome Home Bonus. Massachusetts service members and veterans can now apply online to streamline the application process and expedite bonus payouts. Welcome Home wartime bonuses are awarded to service members who lived in Massachusetts for at least six months immediately prior to entering the military and served on or after Sept. 11, 2001. Qualified applicants can receive bonuses for their active service and deployments in support of the Global War on Terrorism. In 2018, $1.2 million in bonuses were awarded to Massachusetts veterans. Those interested in applying should visit VetsBonusMA.com to upload their required supporting documents from wherever they are. The online application will increase the ability to analyze collected data to optimize outreach to veterans within local organizations and communities, according to state officials. -See the full WickedLocal.com article.
Winter Moratorium on Heat-Related Shut-Offs Extended to April 1 The Mass. Department of Public Utilities has agreed to extend the winter moratorium (preventing heating-related utility disconnections for households with qualifying “financial hardship”), until April 1, 2019. The winter moratorium by law lasts through March 15, but is often extended on a year-by-year basis. Covered utilities: electric or gas utilities that provide heat, or any electricity or gas service that is used for heat or to activate a heating system such as to operate a thermostat. The winter moratorium protects customers whether the utility is investor-owned or municipal-owned. The winter moratorium and other shut-off protections do NOT apply to deliverables such as oil, propane and wood), these companies may refuse to deliver to a customer who has an overdue balance. When Protection Ends Come April 1, utility companies can start shut-off notification procedures for customers with significant over-due bills (“arrearages”) - starting with those who pay nothing each month. Utilities generally do not have sufficient staffing to actually terminate all of those who have arrearages. So customers who pay even a token amount each month will significantly reduce their chances of having their service terminated after the end of the moratorium. Customers with large over-due bills are advised to also see if they are eligible for low-income discount rates and investigate if their utility offers an Arrearage Management Program (AMP), described below, and if they are eligible. Arrearage Management Programs Each investor-owned (i.e., not municipal owned) gas or electric utility company is required to offer a program that forgives past due balances over a period of time if customers pay a budgeted bill each month on time. Each time one pays a bill in full and on time a portion of the overdue bill is forgiven. If, however, the customer misses payments they may be dropped from the program. Eligibility: Basic requirements are that one has a low income (eligible for fuel assistance or a low-income discount) and must have significant arrearages. Additional requirements may include applying for fuel assistance, participating in weatherization/fuel efficiency programs, etc. Apply: Contact the utility company's customer service department (the number should be on the bill) and ask to sign-up for their Arrearage Management Program. -Adapted in part from post on Utility Network listserv, on behalf of Charlie Harak, National Consumer Law Center, February 26, 2019.
Options Counseling Provides Answers on Aging and Disability Options Sometimes people are facing more complex challenges than can be handled by typical information and referral hotlines, situations which require an ongoing approach to ensure their needs are met. In those cases, our Aging Information Center typically recommends Options Counseling, a free program that’s open to anyone over age 17 with a disability and people over 60. For example, we recently heard from a caller who was homeless and losing his Social Security Disability Insurance (SSDI) and SNAP nutrition assistance. We referred the caller to an Options Counselor, who provided information on housing, emergency shelter, and homelessness resources. The counselor also assisted in completing the applications for those programs. Options Counselors frequently provide assistance with services such as the following:
Those are some examples, but the main idea is that we can provide answers when people have questions about aging or disability. And we can also connect people with help and community resources. In practice, Options Counseling starts with a consultation, with follow-up as long as needed. Options Counseling Services
Options Counseling is funded in part by the Massachusetts Executive Office of Elder Affairs and the Massachusetts Rehabilitation Commission. -Adapted from the Somerville-Cambridge Elder Services newsletter article and https://www.mass.gov/service-details/options-counseling-program.
CHAMP Centralized State-Aided Public Housing Application Website The Department of Housing and Community Development’s Common Housing Application for Massachusetts Public-Housing or CHAMP is now online at https://publichousingapplication.ocd.state.ma.us/. If you have an active application at one or more local housing authorities, you can find it on this website and manage it. Once you find your existing application on the website, you can make changes such as updating contact information and adding or removing your applications to housing authorities. Once you update the site, your changes will be recorded at the housing authorities where you have applied. This will help you to make sure that housing authorities know how to contact you and is a great improvement over needing to individually notify each housing authority of a change of address. Those who have never applied for state-aided public housing before cannot at this time apply through the site, but that functionality is ‘coming soon’. Vouchers and federally subsidized public housing units are not yet available through this site. If you are interested in applying for those programs, please contact a local housing authority or regional administering agency (RAA) directly. Visit the CHAMP website: https://publichousingapplication.ocd.state.ma.us/about_us/
HousingWorks Says ALL Subsidized and Affordable Applications Now Available Through Site
(Note: we still cannot respond to any calls or emails from housing applicants: Housingworks staff has the time to keep the system updated but not to train the many thousands of seekers of housing.) -Adapted from HousingWorks: ANYONE can now download all subsidized and affordable housing applications for FREE, and at super fast speeds!!, HousingWorks, John LaBella, February 18, 2019.
Free Tax Filing Assistance for People with Disabilities, Elders and those with Low Income Here are are some resources for free help with filing Massachusetts and Federal income taxes. These resources are for people with disabilities, seniors, and low-income families. Please check each site for eligibility requirements. Income tax help is available in all areas of the state.
This information is found on INDEX/DisabilityInfo.org Free Tax Help and Income Tax Filing Resources Fact Sheet - From Free Tax Help and Income Tax Filing Resources, INDEX/disabilityinfo.org, February 14, 2019.
Food for Free – Food Pantry Home Delivery in Cambridge Food for Free’s Home Delivery brings food to low-income Cambridge residents who cannot access food pantries due to illness or disability. We deliver about 35-40 pounds of food, about half of which is fresh produce, twice per month to more than 140 households. Clients are either seniors and/or people with disabilities, and are unable to access traditional food pantries due to their illness or disability. Unlike meals-on-wheels programs, Home Delivery brings groceries to our clients, so that the recipients can cook their own food. It gives seniors and people with disabilities more control over their meals, while providing a supportive service that helps them to stay in their own homes. Applicants must live in Cambridge, and because of a disability or impairment, be unable to use existing food pantries. Applicants must qualify as low-income under HUD guidelines (less than $34,350 per year for one person) Program Description, Application (en español). Application must be supported by a provider letter- instructions in application. Family Meals Program Launched in the spring of 2016, Family Meals re-purposes prepared foods into single-serving meals for people with limited access to kitchens. Family Meals uses surplus foods from university dining halls and other sources, rescued via our Prepared Foods Rescue program. Working in the kitchen at the Belmont-Watertown United Methodist Church in Watertown, Family Meals staff and volunteers, turn this food into heat-and-eat meals for:
Family Meals distribution sites include:
More information: https://www.foodforfree.org/family-meals -Thanks to Melanie Cohn-Hopwood for sharing this resource.
MassHealth Reminder: MassHealth Extended Eligibility After an Earned Income Increase Note: the below information is not new policy or operation for the TMA program, but clarification on Transitional Medical Assistance end date. MassHealth Transitional Medical Assistance (TMA), is a federal requirement in which MassHealth will provide 12 calendar months of extended eligibility to MassHealth Standard members who would otherwise be ineligible due to an increase in earned income (i.e., from work). The 12-month period begins on the effective date of the increase in earned income. Members will receive a letter letting them know of their TMA period, with a TMA change form they need to complet and return to MassHealth. At the end of the TMA period, members will receive a new notice with additional information, informing them of the benefit for which they are now eligible. If members are not eligible for a MassHealth benefit at the end of their TMA period, they may qualify for a subsidized or non-subsidized health plan through the Health Connector program.
For example, if a household's TMA period starts on 2/1/18 it will end on 1/31/19. On 1/31/19, a program determination will be performed. Beginning on 2/1/19 the consumer will be able to shop and enroll in a Health Connector plan that starts as early as 3/1/19. However, if the household is determined eligible for a non-subsidized Health Connector Plan, their MassHealth benefits will end on 2/14/19. How does Health Safety Net (HSN) work for a person moving from TMA into a ConnectorCare plan?
For example: If TMA ends on 2/28; the consumer will have access to 90 days of HSN beginning on March 1.
Remember, the Health Connector's Special Enrollment Period (SEP) is for 60 days. If the consumer does not enroll by the 23rd of the additional month of TMA, they will have a gap in coverage. They may still have HSN benefits but must choose a later start date for their Health Connector plan, which always begin on the 1st of the month. -Adapted from Understanding MassHealth Transitional Medical Assistance (TMA), MA Health Care Training Forum, February 14, 2019.
Medicare Reminder: Durable Medical Equipment Medicare Part B covers durable medical equipment (DME), which is equipment that serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home.
Note: If Medicare denies coverage for your DME, you have the right to appeal the decision. Competitive Bidding Program Pause Reminder that as reported in November (Medicare Announces Two-Year Gap in Competitive Bidding Supplier program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies [DMEPOS]), on January 1, 2019, the durable medical equipment (DME) competitive bidding program temporarily ended. It is expected to begin again in 2021.
Boston Allocates $26 Million For Affordable Housing Developments The city of Boston has allocated $26 million to fund affordable housing at 10 projects, Mayor Marty Walsh and city housing officials announced this month. Sheila Dillon, the mayor's chief of housing, said an additional $5 million would be used to buy existing apartment buildings and permanently restrict them as affordable housing units. Furthermore, the new funding also calls for $3 million to assist with down payments for first-time homebuyers, Dillon said. The development plans also listed the renovation of the Knights of Columbus headquarters in the North End, which would become a 23-unit affordable housing complex for the elderly. The building was sold to the city to create new housing for baby boomers who were priced out of the area and sought to return, Walsh said. The majority of the 515 units in the development plans will be accessible to households that consist of a family of four who make $65,000 or less, housing officials said. The city will maintain the units at an affordable rate by restricting their rates for 50 years. Although the city and local partners have committed initial funding, officials said only the deed-restricted homes could begin development this year. The rest would need additional funding from the state’s housing authority, estimating that the other projects could not begin until next year at the earliest. A list of the developments outlined can be found here. - See the full WBUR story.
Legislators Seek Right to Counsel for Those Facing Eviction An estimated 43 evictions a day happen around Massachusetts, in one of the nation’s priciest rental markets. Tenants must often represent themselves in court, as they seek to stave off homelessness. More than 90 percent of Massachusetts renters facing eviction represent themselves. Eviction initiations in Massachusetts spiked in 2008, following the Great Recession. Each year since then, landlords have sued about 40,000 heads of household across the state seeking to evict them, according to data gathered by the New England Center for Investigative Reporting. The state doesn’t track how many of these have resulted in actual evictions, but the Eviction Lab at Princeton University found that in 2016, there were roughly 15,708 forced removals in Massachusetts — an average of nearly 43 a day. That’s about double the number of evictions in 2005, before the housing bubble burst, and it probably does not reflect how many people are displaced, since it does not include the number of renters who leave once they get their notice, and those who strike deals with their landlords to stay temporarily. Some legislators and activists say that evictions disproportionately affect the poorest, most vulnerable members of our society, who, like Stanley, end up in court without legal representation. “It is David versus Goliath,” says Sal DiDomenico, a state senator from Everett. “People who are low income don’t have the resources to compete.”
DiDomenico introduced a bill in January, an act to ensure right to counsel in eviction proceedings, to provide legal counsel to low-income tenants — part of a package of bills supported by Boston Mayor Martin J. Walsh to reduce displacement and help low-income residents. On a practical level, providing tenants with attorneys could defuse some of the raw emotion of eviction court, says Framingham real estate attorney Richard Vetstein, who adds, “I’ve been chased down by many a tenant, threatened in the parking lot, threatened in the hallway.” But many landlords are skeptical. While landlords have the right to evict tenants without cause and take back their properties, state laws already provide numerous defenses to renters to help ensure fair treatment. “The playing field from the landlord’s point of view is already skewed in favor of the tenant,” says Peter Vickery, a lawyer for the Cambridge-based MassLandlords.net, which represents thousands of smaller property owners. Vickery wrote a blog post in January linking the right-to-counsel movement to the Democratic Socialists of America, which among other things wants to eliminate evictions entirely. He says that if low-income tenants get free attorneys, so should small landlords. The lawyers who volunteer at legal aid services often can only provide brief advice to people who approach them while they’re at the housing court; DiDomenico’s bill would give tenants full representation, similar to a public defender in criminal court. Housing court judges often encourage renters and landlords, or their attorneys, to head down to the third floor of the courthouse, where court mediators try to broker deals that can involve a reduction in what is owed, a payment plan, or a move-out date. Having access to an attorney can be particularly helpful in this part of the process, housing advocates say, because desperate renters often agree to terms they don’t actually understand or can’t honor. -See the full WGBH story.
Spousal Impoverishment Protections for Medicaid Home and Community Based Waivers May Expire at the End of March Earlier this year, thanks to collective advocacy, Congress extended the "spousal impoverishment protections" that make it possible for an individual who needs a nursing home level of care to qualify for Medicaid home and community-based services (HCBS) while allowing their spouse to keep a modest income and resources to support their basic needs. Unfortunately, the extension was only for 3 months, meaning these important HCBS protections will expire on March 31st unless Congress acts to create a longer-term solution. Medicaid's "spousal impoverishment protections" make it possible for an individual who needs a nursing home level of care to qualify for Medicaid and receive long-term services and supports, while allowing their married spouse to retain a modest amount of income and resources to pay for rent, food, and medication. Congress extended this protection to eligibility for HCBS in all states beginning in 2014, providing married couples the same financial protections whether or not care is provided in a facility or in the community. Allowing the protection to expire now could force people who are now eligible for HCBS into more costly institutional care against their wishes and separate them from their spouse and loved ones. It would also stall or even reverse progress states have made in helping older adults and people with disabilities remain at home and in the community. -From Tell your Senators: Protect Seniors Who Receive Medicaid HCBS from Impoverishment, Justice in Aging, February 12, 2019.
Social Security Administration Proposes Eliminating Limited English Proficiency as Factor in Disability Determination On February 1, the Trump Administration announced a new proposed rule which threaten access to basic needs programs. The Social Security Administration (SSA) announced a proposed rule change that would remove the “inability to communicate in English” from the list of educational categories that are considered when SSA determines who qualifies to receive Supplemental Security Income (SSI) and Social Security Disability (SSDI) benefits. More background and information is available in this article. Public comment is open until April 2, 2019. -Adapted from New Threats from The Trump Administration, Co Chairs of the Protecting Immigrant Families Campaign, February 11, 2019.
Medicare Announces Emergency Triage, Treat and Transport (ET3) Model to Reduce Unnecessary Emergency Department Use The Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program— recently announced a new model within traditional Medicare that could help people with Medicare avoid unnecessary trips to the Emergency Department. This new model would allow emergency transportation services to take individuals to their primary care doctor or urgent care, or to deliver treatment in place, when the person does not need to be seen in an emergency room. Currently, most emergency transportation after a 911 call is limited to taking the patient to the Emergency Department of a nearby hospital. This can mean that Medicare beneficiaries are exposed to the expense and stress of an emergency room visit when they may really need to see their primary care doctor or to receive limited treatment in their homes. The Emergency Triage, Treat and Transport (ET3) model would allow participating ambulance suppliers and providers to partner with providers to deliver treatment in place when appropriate. This could be either on-the-scene or through telehealth. When such treatment is not appropriate but the condition does not require immediate transportation to an Emergency Department, the model would allow the ambulance to deliver the patient to alternative destination sites such as primary care doctors’ offices or urgent-care clinics. The Medicare Rights center says “The details of such models are extremely important and CMS must ensure that people with Medicare receive appropriate care when they face a medical emergency. We welcome efforts to keep people out of the Emergency Department when safe and feasible, though we cannot be sure yet if this model will have the necessary safeguards. We will continue to monitor this model and other models CMS publishes to ensure they support high-quality, affordable care for people with Medicare.” Read more about the new model. - Adapted from the Medicare Rights Center blog post
Veterans Will Have More Access to Private Health Care Under New V.A. Rules Veterans who live as little as a 30-minute drive from a Veterans Affairs health care facility will instead be able to choose private care, the most significant change in rules released recently as part of the Trump administration’s effort to fix years-old problems with the health system. Veterans who can prove they must drive for at least 30 minutes to a Department of Veterans Affairs facility will be allowed to seek primary care and mental health services outside the department’s system. Current law lets veterans use a private health care provider if they must travel 40 miles or more to a V.A. clinic. Measuring commuting time rather than distance will greatly open the private sector to veterans in rural and high-traffic urban areas. Supporters say the new policy, which is likely to go into effect in June, will help veterans get faster and better care. But critics fear it will prompt the erosion of the largest integrated health care system in the country as billions of dollars are redirected to private care. Current law lets veterans facing a wait of 30 days or more for an appointment at their closest V.A. facility seek private care, but under the new policy, that would be reduced to 20 days, and with the goal of 14, by 2020. Veterans will also be allowed access to walk-in clinics; however, those will require co-pays for treatment after a third visit. If seeking a specialist after the new policy takes effect, veterans must prove a drive of at least 60 minutes. Congressional Republicans and the Trump administration have been greatly influenced by Concerned Veterans for America, an advocacy group with ties to the billionaire industrialist brothers Charles G. and David H. Koch, which has long championed expanding the use of private health care for veterans. Traditional veterans service organizations, which have largely opposed these changes, have had less say under Robert Wilkie, the secretary of veterans affairs. Critics fear that private health care, which tends to have higher costs than government-provided care, will force the department to cut corners elsewhere. Mr. Trump has instructed his cabinet secretaries to cut each department’s budget, and a prior budget agreement that lifted caps on spending is set to expire soon, leading many to wonder if Veterans Affairs will be able to pay private providers and maintain its own services. The Department of Veterans Affairs will remain at the center of care coordination, and the private providers — who would be paid by the department at rates roughly comparable to the Medicare program — would not be permitted to cherry-pick the healthiest patients, V.A. officials said. About 26 percent of veterans pay a co-payment, and they would have similar co-payments at private doctors. The department, however, has struggled greatly with its information technology systems in recent years, and studying those systems is now the purview of a House subcommittee. Whether the department can successfully coordinate care with myriad health care providers will be a concern that Congress will doubtlessly follow. -See the full The New York Times article.
Opinion: CMS Proposal Would Allow Medicare D and Medicare Advantage Plans to Further Limit Prescription Access The Medicare Rights Center recently responded to a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would, in part, allow Part D and Medicare Advantage (MA) prescription drug plans greater flexibility in managing their formularies. According to CMS, the proposed policies are intended to “remove administrative hurdles to offer lower cost options to seniors and provide support for private sector partners by providing them the tools to lower the cost of prescription drugs.” While we agree with the need to address high and rising drug prices, we strongly disagree with the agency’s proposed approach, which seeks to do so by weakening the protected classes protections and permitting step therapy for Part B drug coverage. Such changes have the dangerous potential to disrupt or even end access to some medications for people with Medicare. Currently, Medicare drug plans are generally required to cover all of the available drugs in six categories known as the “protected classes.”: These categories include anti-depressants, antipsychotics, anticonvulsants, immunosuppressants for transplant rejection, antiretrovirals and antineoplastics. Under the proposed rule, plans would be able to limit or exclude coverage of drugs in the protected classes. Medicare Rights continues to find this suggested change extremely troubling, as these medications are not easily substituted and interruptions in drug therapies could have significant individual and public health consequences. Similarly, CMS’ proposal to allow MA plans to utilize step therapy on Part B drugs (only covering certain drugs if a person tries a preferred medication first and it doesn’t work or causes them harm) would also have negative impacts on beneficiary health and well-being, by limiting beneficiary access to these medications—including in the treatment of life-threatening conditions like cancer—and by making comparing plans even more difficult. -See the full Medicare Rights Center blog post.
5 Things to Consider When Facing Loneliness Later in Life Loneliness is a common problem for older adults, and there is a growing body of research that indicates it can be hazardous to your health. Finding ways to reconnect with social pursuits is a great way to combat loneliness. Here are some other quick pointers: Isolation or loneliness? These are two different things, but they can be related. Isolation is when someone has limited social interaction. It’s about quantity, not quality. Increasing activities and the amount of time spent around people are the best ways to mitigate isolation. Loneliness is a subjective experience, because it’s when someone feels that they’re not having enough social interaction. There is a gap between the desired level of social engagement and the actual level of engagement. This is often about the quality of the relationships that a person has. This might seem like a small distinction, but it’s actually important to understand the difference. It is possible to be isolated but not particularly lonely. That said, it is usually a good idea to reduce isolation, because it increases risk for falls and poor health outcomes, especially with older adults. The right level of interaction will be different for each person. For example, if a person has always been an introvert, that’s probably not going to change. The key is finding something interesting and engaging, even if it is just having a friend or volunteer drop by and visit. Re-establishing connections can be a very effective way to combat isolation or loneliness. People fall out of touch for many reasons, and understanding why is often an important first step. Building and maintaining meaningful relationships is the best way to combat loneliness, and sometimes that’s as simple as reconnecting with old friends. The Internet offers many tools that make reconnecting easier. Social media, video chats, online forums for topics of interest—these are all ways that people can connect. Sometimes it just takes a little effort and assistance with the setup. If the issue is more isolation than loneliness, a person may be content with their social relationships but feel bored or purposeless, or perhaps crave the stimulation of social interactions. Isolation can be addressed by reconnecting with social spaces that previously brought joy. This could be exploring museums, attending concerts or events, or just being out in public spaces. Rethink transportation Driving is a central component for many people’s lives, and it takes some adjusting when that changes. Sometimes people become isolated when they haven’t found the right replacement for driving. A small thing like setting up an Uber or GoGo Grandparent account or reviewing public transit options can make a big difference. Be mindful of memory loss Social interaction generally boosts mood, improves cognitive health and slows cognitive decline. But memory loss can sometimes require rethinking social interaction. Dementia-friendly spaces can be helpful here. One example is Memory Cafés, which are social events that are safe and welcoming for people with memory loss. Elder service agencies are often a good starting point for learning about dementia-friendly resources in your community. Hire a professional? An Aging Life Care Manager (ALCM) can help with several aspects of loneliness and isolation. The initial assessment should check for both, with the ALCM getting a sense of both the current amount of social interaction and if it is meeting the person’s needs. If there is an issue, they should be able to help, through a combination of recognizing barriers to socialization and providing resources. -See the full Somerville-Cambridge Elder Services’ Eldercare.org article |
