June 27, 2023 Newsletter

By: Amy Copperman

MLPB Executive Director

June 27, 2023

Since the end of the COVID-related Public Health Emergency in May, the redetermination process for Medicaid has been proceeding at a fast clip with profound implications. More than one million Americans have already lost their coverage since the process began. The New York Times reported recently that most were dropped for procedural reasons, rather than because a state determined affirmatively that the recipient was no longer financially eligible.

Medicaid, our country’s health insurance program for millions of low-income Americans, offers so much more than affordable sick care. Through a waiver process, states have the option to use Medicaid funding to implement a wide range of innovations focused on social care for the whole patent. 

The MLPB model is a prime example of one such innovation, and we are proud to partner with Medicaid waiver-funded entities in both Massachusetts and Rhode Island, including Community Care Cooperative, the Boston Accountable Care Organization, Steward Medicaid Care Network, Integra Community Care Network, CharterCare Health Partners, and Thundermist Health Center.

These health care organizations are breaking new ground with their approach to social care for Medicaid recipients. Medicaid provides an opportunity to bring health promoting strategies into the health care space, to treat the whole patient, and to move the needle on population-wide health. But patients don’t get access to these expansive services unless they are on Medicaid. Those who are losing Medicaid are also losing out on the opportunity to be treated by health care teams who understand that food insecurity, housing needs, systemic racism and poverty are all intrinsically connected to health. And no one is measuring the impact of this loss.

This is no time to backslide on building care systems that broaden the idea of what is truly needed to become a healthful society. MLPB supports the Biden administration which has implored states to slow down the Medicaid redetermination process. There is time to make sure every step is taken to protect eligible individuals and families from procedural terminations.

By: Nedhi Teixeira

MLPB Law & Policy Consultant

April 13, 2023

Poor housing conditions lead to poor health conditions 

Imagine going to court to seek help for a pest infestation in your apartment and realizing you are being evicted instead! Unfortunately, the Massachusetts Supreme Judicial Court – the highest court in Massachusetts – has recently determined that this is possible. The evidence is clear that housing and health go hand in hand – poor housing conditions lead to poor health. Massachusetts has a Sanitary Code to provide regulations for safe and habitable housing and Housing Courts are invested with the power to ensure that landlords comply with that code. However, it can be challenging for tenants to enforce their rights to healthy housing.  

What happened in the case of Jason Dacey v. Sandy Burgess 

Jason Dacey, a disabled single parent of three children who suffered from depression and bi-polar disorder, lived in an apartment in Haverhill, MA where he encountered an issue with bedbugs. When his landlord failed to address the problem, he sought relief from the Northeast Housing Court. Usually, tenants go to court as a last resort to get an order to force the landlord to fix the conditions. The process requires the tenant to file a civil complaint requesting an injunction – an order telling the landlord they must fix the bad condition immediately. At court, Dacey and his landlord’s attorney entered into mediation, a regularly utilized process in the Housing Courts to resolve landlord tenant disputes before a trial. At that time, Dacey did not have an attorney, while his landlord was represented by counsel. Mediation concluded with an agreement between Dacey and his landlord stipulating, among other things, that Dacey would move out of the apartment by a specific date. Rather than getting the Housing Court to issue a judgment ordering the landlord to make repairs, he instead left with an order requiring him to leave his apartment.  

Dacey appealed the Northeast Housing Court’s judgment, and the Massachusetts Supreme Judicial Court heard the case. Before the decision in Dacey, landlords have been required to file a specific petition called a “summary process” case to seek to evict their tenant. The summary process statute requires that a court issue an execution – a document ordering the tenant to leave the premises – prior to a tenant being evicted. The SJC had to decide if Dacey could still be evicted in these specific circumstances through a housing court mediation process that occurred not in the context of a summary process proceeding, but in a Civil Relief injunction action filed by the tenant.  

Health equity considerations for the Commonwealth 

MLPB submitted an Amicus letter to the Supreme Judicial Court in support of Dacey outlining the health impacts of this case on the Commonwealth’s renter population. MLPB highlighted that this case exemplifies the power dynamic in eviction cases where a majority of landlords are represented by attorneys while most tenants are not, and it reinforces the choice tenants facing poor housing conditions are forced to make when the systems in place to help them fail – to remain in unhealthy housing or to be homeless. These circumstances are even more greatly felt by communities of color and low-income households – data shows that exposure to poor housing conditions and evictions disproportionately impact communities of color. While problems with occupied units – the oldest housing stock in the nation – exist across the Commonwealth, the response of certain inspectional services departments can be slow to rectify the issues.  

What we can learn from the Dacey case 

Sadly, on February 16, 2023, the SJC issued an order agreeing with the Northeast Housing Court’s decision to enforce the agreement Dacey and his landlord entered, and to ultimately evict Dacey. In that order they also stated that Dacey did not provide evidence that he properly alerted the court of his disability, which would reflect his inability to enter into the agreement. The SJC further clarified that the courts must provide a reasonable accommodation to an individual entering into an agreement who has a disability effecting their capacity to enter that agreement but only when the individual properly alerts the court (with medical evidence) – resulting in the net decision adding to the burdens of tenants seeking relief in Massachusetts courts. 

Although Dacey did not receive the outcome he expected, this decision provides some important takeaways for tenants and tenant’s advocates in Massachusetts: 

  • In Massachusetts courts, it is possible to receive an outcome of eviction in an action requesting the court to order landlord to fix bad conditions. 
  • Tenants should always read and review agreements carefully before signing and agreeing to any terms.  
  • Tenants can consult with an attorney before signing any agreements. They have a right to seek counsel at any point in the mediation or court process.  
  • If a tenant has a disability which impacts their ability to enter into an agreement at any time, they should unequivocally alert the court during the proceedings with presentation of medical evidence.   

By: Kate Gannon and Marsophia Ducheine

MLPB Law & Policy Consultants

March 13, 2023

As two of MLPB’s Law and Policy Consultants, we frequently field questions from care teams about how to help families maximize their household income. Tax season can feel daunting, but in reality, if taxes are filed correctly, low-income families can often end up with additional income. An expected tax rebate can even be used to help families stay housed. Care teams should encourage families to get their taxes filed and on time. Here’s a roundup of the topics we see most often:

What if the family cannot afford an accountant?

  • Refer them to a local tax assistance location for free tax return preparation assistance from the Volunteer Income Tax Assistance (VITA), Tax Counseling for the Elderly, or the AARP.

What if English is not the family’s preferred language?

  • Many tax forms are only available in English; however, care teams can still share basic tax information in 20 languages.
  • Care teams can also refer any person with “limited English” to a local VITA program.

What if the person does not have a social security number?

  • People without social security numbers can still file taxes with an Individual Taxpayer Identification Number (ITIN). Care teams can share information on how to apply for an ITIN.
  • There are additional benefits to using an ITIN for people without immigration status. Care teams can share Protecting Immigrant Families’ resource titled “Your ITIN, Your Money” (available in English and Spanish).

What if someone wants to complete their taxes online?

What if someone receives a text message from the IRS about their return?

  • Remind them that the IRS does not send emails or text messages asking for financial information. Care teams can help people avoid scams by sharing information about common phishing techniques.

Know Your Limits! Even with all of these resources, there will be times when someone has a complicated tax issue that requires an attorney. Care teams can refer them to legal assistance.

Visit MLPB’s Digital Digest for more information about where to go for help.

By: Kate Gannon – Law & Policy Consultant, MLPB

December 20, 2022

One of the most fulfilling parts of my work at MLPB is supporting helping professionals who have answered a deep-seated call to care for others. As a Law & Policy Consultant, I have the privilege of participating in interdisciplinary team meetings where I further MLPB’s mission of spotlighting legal rights and protections that can be leveraged to increase the wellbeing of those served. Together, we engage with legal problem-solving. While I relish the highs that I have the privilege to witness, I also sit with my colleagues in the lows. Often, these lows are referred to as compassion fatigue, the burden shouldered by those who seemingly “care too much.” But perhaps it’s time to rethink this description?

Earlier this year, I attended a presentation led by Dr. Christina Bethell, Director of the Child and Adolescent Health Measurement Initiative and Professor at the Johns Hopkins Bloomberg School of Public Health, during the second annual HOPE Summit. Dr. Bethell planted a seed that for me has since grown into a personal maxim, “Compassion fatigue is a misnomer.” It is not the caring or the connecting that brings us down, it’s the inability to eliminate the suffering, a heavy symptom that Dr. Bethell has aptly retitled “fixing fatigue.”

Essentially, care teams are in the business of bearing witness to the suffering of others. They also are human. They feel empathy, often deeply understanding and identifying with the pain felt by those they support. By their nature, they take steps to try to alleviate some of that pain. As Dr. Bethell explained, the discomfort comes not from engaging in those compassionate acts, but from the empty feeling that remains when care team members realize they cannot eliminate the suffering, or “fix” things. It’s been described by some of my colleagues as a kind of profound powerlessness.

I want to offer my human-centered colleagues who seemingly “care too much” the same relief that Dr. Bethell gave to me: We don’t have compassion fatigue. A simple act of compassion, even just taking a moment to listen, is a human connection that is as important for the giver as it is for the receiver. (For instance, a clinical trial demonstrated that oncology patients who received just 40 seconds of compassionate physician care were significantly less anxious.1 Meanwhile, a study of medical students showed that delivering compassionate care increased overall staff wellbeing.2) However, we may have fixing fatigue, an exhaustion for which the cure is not less compassion, but leaning into compassion as both an act of kindness to the people we serve and to ourselves.

  1. Thomas MR, Dyrbye LN, Huntington JL, et al. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med. 2007;22(2):177-183. doi:10.1007/s11606-006-0039-6.
  2. Fogarty, LA, et al. Can 40 seconds of compassion reduce patient anxiety? Journal of Clinical Oncology. 1999; 17(1), 371-9.

Amy Copperman to lead MLPB’s next chapter of impact

Amy Copperman, a seasoned and creative access to justice system-builder, will take the helm at MLPB in early January 2023. Since 2015, Copperman has led AmeriCorps Legal Advocates of Massachusetts (ALA-MA), an innovative state-wide program that deploys national service corps members — most of whom are not licensed attorneys — to advance access to justice in the Commonwealth. Before joining ALA-MA, Copperman was a healthy eating educator operating in several settings and a staff attorney at the Massachusetts Law Reform Institute (MLRI). At MLRI, she specialized in housing law and policy and democratizing access to justice for people impacted by housing instability and homelessness.