Grant Partners

Ecu-Health Care will conduct outreach in partnership with local community organizations and institutions; provide direct-to-consumer outreach via phone or mailings to Berkshire Medical Center uninsured patients as identified through an automated referral system; partner with other area health and human service organizations to establish an online referral system; review with clients the contents of a member packet including information on what changes to an account need to be reported, staying healthy with your new insurance, eligibility and benefits, how to make a payment, and advanced premium tax credits; and expand digital media, billboards, public broadcast, and radio advertising.

Edward M. Kennedy will expand assistance on weekend hours; assist in educating about 13,500 MassHealth patients who will be impacted by changes related to the 1115 waiver and transition to the Accountable Care Organization model; verify the insurance status of current patients days in advance of upcoming appointments; work with insurers to identify members who are up for renewal and provide assistance; formalize an outreach and enrollment network to identify at-risk individuals and refer them to the Outreach/Enrollment team; and partner with community centers and places of worship. 

Health Care For All (HCFA) will work to protect and expand affordable, accessible health care within Massachusetts by advocating for the continuation and improvement of state and federal health and safety net policies. As a leader of the Oral Health Advocacy Task Force and the Affordable Care Today (ACT!!) Coalition, HCFA will educate policymakers about health care access issues and will engage in community organizing, coalition-building initiatives, and media outreach. Additionally, they will seek to identify under-resourced but effective mental health programs that may benefit from expansion.

Citizens' Housing and Planning Association (CHAPA) is the leading statewide housing policy and research organization in Massachusetts, and manages the On Solid Ground (OSG) Coalition, which includes organizations in housing, health, education, employment, legal services, and faith-based communities advocating for increased housing and economic stability for families, thereby improving housing, education, income and health outcomes.  CHAPA will conduct outreach and education to affect policy and systemic change at the intersection of health and housing. 

Massachusetts Association of Community Development Corporations (MACDC), in partnership with the Mel King Institute, will train community developers and offer technical assistance to help them partner with local hospitals to address the social determinants of health at the community level.  Content of the trainings include hospital Community Benefit programs, the Determination of Need program, reforms to health care under Medicaid and requirements for Accountable Care Organization models, and successful examples of partnerships between the hospital and housing communities.  This program seeks to build partnerships with community developers, as hospitals are addressing the needs identified in their own Community Health Needs Assessment processes. 

The Massachusetts League of Community Health Centers (the League) will address the changes in the policy and health care environment with vulnerable populations, community health centers, and their communities.  A main goal is to analyze health care reform policies, monitor proposals for change, and educate community health centers and partner organizations. The League will also assemble health centers, community members, providers, and advocates in an action-based coalition for maintaining and expanding coverage.

Friends of Jewish Community Housing for the Elderly (JCHE) provides supportive, affordable, independent senior housing in Massachusetts, and owns 1,200 apartments that are home to 1,500 low-income older adults in Brighton, Newton, and Framingham.  In collaboration with the LeadingAge Center for Applied Research, JCHE will seek to demonstrate the effectiveness of affordable housing on the quality of life for the organization's seniors, as well as an impact on costs to the government and health care system.  It will include metro Boston seniors who are low- and moderate-income with similar demographics (income, age, ethnicity, risk profile) living in subsidized housing and receiving supportive services.  The provision of housing will be studied as an intervention at three levels, using Medicaid and Medicare utilization data:  1) housing without services, 2) housing with resident service coordination only, and 3) housing with significant service enrichment. 

Greater Lynn Senior Services (GLSS) is a Massachusetts' designated Area Services Access Point, and the principal source for home, community-based, and long-term support services for more than 30,000 low- and moderate-income elders, adults living with disabilities, and their families/caregivers.  The organization is focused on building healthy and more livable communities, where critical home and community-based services and supports are required to promote residents' optimal independence and well-being.  GLSS, in partnership with Boston University's Center for Aging and Disability Education and Research (CADER), will develop an evaluation framework for its Kiosk for Living Well program, which deploys vibrant, mobile spaces embedded in community pulse-points that inspire consumers to participate in activities designed to promote healthier living routines.  Currently situated at four senior centers and three housing complexes, kiosks represent community hubs designed to strengthen clinical-community linkages, facilitate health care access, and provide health monitoring and assessments.  The evaluation will deliver an evidence-informed assessment of both early impact and ongoing potential of the kiosk concept as a model for integrating health care and social services.   

Massachusetts Law Reform Institute’s (MLRI) health care work targets vulnerable populations who face unusual challenges in obtaining and maintaining health insurance coverage and care. MLRI will provide legal advocacy focused on policy and regulation issues in the Commonwealth in defense of low-income and vulnerable populations. One key issue is retaining coverage for those affected by redetermination through detailed critiques and analyses to identify standards and practices that are not in compliance with applicable law.

South Middlesex Opportunity Council (SMOC) provides housing and supportive services to disadvantaged, homeless, single adults in three regions of the state:  MetroWest/Framingham, Central Mass/Worcester, and the Merrimack Valley/Lowell.  SMOC will evaluate the impact of its Housing First program that recognizes an immediate and primary focus on helping clients access and sustain permanent housing, to test the hypothesis that stable housing leads to improved health outcomes, and ultimately, a reduction in health costs.  Three hundred clients will be placed into housing and evaluated as part of this project.  SMOC will identify those clients with the highest service needs at entry into shelter, and then follow them into and throughout their housing placement in order to measure their health outcomes at various points along the continuum of homelessness and housing.

Harbor Health Services will participate in off-site joint outreach sessions at social service agencies, supermarket chains, ethnic markets, Councils on Aging, Veterans Agencies, sites serving behavioral health and developmental delayed persons, subsidized housing, state employment and job training sites, schools, food pantries, WIC program sites, health fairs, and via social media. It will create a health insurance literacy community assessment, and develop user-friendly materials that educate clients on how to use health insurance benefits. Finally, it will dedicate a phone number and webpage for residents to reach staff for enrollment assistance, and execute a social media campaign.

Family Health Center of Worcester (FHCW) will partner with community organizations to receive referrals for individuals needing enrollment assistance. They will provide one-on-one sessions and events about minimizing the risk of losing coverage, review all eligibility determination letters, utilize its EMR to record pending expiration dates, and use automated call center software to reach uninsured patients in multiple languages. The organization will conduct quarterly “health insurance 101” trainings, provide regular patient orientation sessions, and make health insurance literacy information and resources available through patient computer kiosks.

The Massachusetts Senior Action Council (MSAC) will address key public policy and community issues affecting the health and well-being for the 65 and over population, empowering its members to use their own voices to address key public policy and community issues. Advocacy will focus on the growing disparity in out-of-pocket costs and affordability. MSAC will coordinate the “Bridge the Gap” campaign, which focuses on health care affordability for seniors.

Project Directors: Megan Sandel, MD, MPH and Diana Cutts, MD

“Children's HealthWatch - Housing Vital Sign” is a one year project to develop a three-question screening tool to identify housing instability – to be called a “Housing Vital Sign.” While there is growing interest by health care providers in connecting patients to services that address social determinants of health, providers struggle to systematically identify which patients are in need of these services. There are currently no validated measures for universal use by health care providers for identifying housing hardships. This project aims to address that gap. Building on their experience developing and validating a two-question screening tool for food insecurity (Hunger Vital Sign™), the research team will leverage its database of nearly 60,000 patients to identify combinations of up to three housing instability questions with the highest association with adverse health and developmental outcomes among families with young children.

Dukes County will participate in community outreach events, and use paid and unpaid advertising and social media to promote affordable insurance information. They will develop a folder with handouts for appointments, and adapt a checklist for account set-up, enrollment and payment information, primary care provider selection, and making appointments. It will also set up reminder systems for clients with pending action steps.