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Achieving a Racially and Ethnically Equitable Health Care Delivery System in Massachusetts: A Vision and Proposed Action Plan

December 13, 2023

This report proposes a vision and plan for action—collectively a statewide Health Equity Action Plan—for achieving a racially and ethnically equitable health care delivery system in Massachusetts. The report is accompanied by an Executive Summary, as well as a Health Equity Action Plan Toolkit (Toolkit) of interventions, policies, and programs that organizations in the health care delivery system can deploy to achieve their health equity goals.The causes and impact of health inequities in Massachusetts, as elsewhere, are multiple, complex, and inter-related. Inequities in access to adequate housing, food, education, and other vital needs are stark and directly impact people's health. Many populations experience health inequities, including people of color and people for whom English is not their primary language, as well as those with disabilities and those in the LGBTQ+ community. The focus of this report is on racial and ethnic inequities in the health care delivery system and therefore can be considered a first phase in a larger system-wideeffort to eliminate all inequities that affect people's health.

Who Counts in Climate Resilience?: Transient Populations and Climate Resilience in Boston and Cape Cod, Massachusetts

September 1, 2023

In the Northeast U.S., climate change impacts are predicted to increase and intensify unless global carbon emissions are reduced enough to mitigate impacts on local municipalities. As a result, thousands of people in Massachusetts are vulnerable to dynamic and extreme weather conditions, including temperature fuctuations and precipitation patterns, particularly those who are socially, politically, or economically marginalized. While decision-makers in Boston and Cape Cod municipalities must consider diverse stakeholder needs, one population is notably missing from most climate resilience efforts: people experiencing transience, due to housing insecurity.Within the Commonwealth there are two transient populations who are among the most climate vulnerable: people experiencing homelessness, and international seasonal H-2b workers. Both groups are vulnerable due in part to housing insecurity, poverty, and regular exposure to climate change and related weather impacts. To date though, very little data on their environmental exposure and experiences have been collected. To address this, a team of social and environmental scientists at the University of Massachusetts Boston conducted qualitative and quantitative data analysis, a survey, and interviews. While quantitative data represented the entire Commonwealth, survey responses and interviews specifically represented two regions where people experience transience and climate change impacts: the city of Boston and Barnstable County (Cape Cod). Research goals included learning what climate change impacts and weather conditions transient people in coastal Massachusetts are exposed to, how municipal social and environmental sectors engage, prioritize, and respond to these populations' climate and weather-related needs, and if there are cross-sector collaborations.

The MassHealth Demonstration Extension 2022–2027: Building on Success, Focusing on Equity

June 27, 2023

Massachusetts administers much of MassHealth through an 1115 Demonstration waiver, approved by the Centers for Medicare and Medicaid Services (CMS), which it has extended several times since it was originally approved in 1995. On September 28, 2022, CMS approved Massachusetts' request for a five-year extension of its Demonstration, which is in effect from October 1, 2022 through December 31, 2027. While the latest approved Demonstration largely aims to continue and improve upon the programs and initiatives that were part of the previous Demonstration, an area of specific focus within this extension is advancing health equity within the MassHealth program. As part of this, MassHealth seeks to promote health equity by both building on current program elements and introducing new strategies such as investing in certain populations that experience persistent health disparities and creating incentives for ACOs and hospitals to measure and reduce health disparities.This report and accompanying infographic describe the approved MassHealth Demonstration extension, what it means for MassHealth coverage moving forward, and implications for members, providers, and Massachusetts.

Cash Empowers: Rise Up Cambridge bridges gaps for families

June 27, 2023

The brief by the Cambridge Community Foundation (CCF) reveals the pressures low-income families are facing in a city whose cost of living is 73 percent higher than the national average. CCF found that:Just over 60 percent of Cambridge's Black and African American families with children make half or less of what the Economic Policy Institute considers a living wage.The median income of single mothers is $29,000—just 15 percent of the $191,000 citywide median for married couples with kids.More than half of the people in eligible families are 21 or younger, with the largest share under age 12. That's nearly 4,000 Cambridge children whose circumstances make it hard for them to live up to their potential and become thriving members of the community.The Rise Up Cambridge program aims to help change these statistics. It is a $22 million City of Cambridge program run in partnership with Mayor Sumbul Siddiqui, the Cambridge Community Foundation, and Cambridge Economic Opportunity Committee that supports families with children making up to 250 percent of the federal poverty line—$66,250 for a family of four. The program is the only one in the country that's not lottery-based, offering all eligible families $500 cash assistance for 18 months. Funds will be distributed beginning July 1.

Building a Better RAFT: Improving Access to Emergency Rental Assistance in Massachusetts

May 25, 2023

The Residential Assistance for Families in Transition program, better known as RAFT, is a vital lifeline for thousands of families each year who find themselves in danger of homelessness. It provides temporary housing resources to thousands of families each year, thanks to the critical partnership of community-based organizations (CBOs) and regional administrators, who make the complicated system easier for recipients. But could RAFT be more effective? The answer is unequivocally yes. In this report, four organizations with experience in the housing sector - TBF, CHAPA, the Metropolitan Area Planning Council and the United Way of Massachusetts Bay - draw up a list of policy recommendations that could make resources easier to access and more available to families in need.In addition to increasing funding, the brief calls for efforts to simplify and streamline a fragmented system, reduce burdens on applicants for RAFT, and provide resources and other supports for CBOs to better serve applicants throughout the process.

2022 Annual Report: Amplifying Voices

May 25, 2023

During 2022, we aimed to amplify the voices of those working on issues that affect Massachusetts residents' ability to access health care and we use our own voice to call attention to our key focus areas. Through our grantmaking, policy and research, and convenings, we will continue to center the important voices that are often left out of the conversation.

Addressing Extreme Heat in Boston: Engaging the Business Community in Heat Resilience Solutions

May 11, 2023

A Better City is exploring ways for member businesses and institutions to support extreme heat resilience and help protect both the built environment and vulnerable populations alike. As a complement to the City of Boston's Heat Plan, 20-Year Urban Forest Plan, and the ongoing leadership of community-based organizations, opportunities for engagement may include community heat resilience pilot projects, heat policy principles, and ongoing collaboration through an Extreme Heat Working Group. This extreme heat primer is intended to provide baseline context on what Boston has done to date on heat resilience and urban forestry and to provide opportunities for businesses to engage in extreme heat solutions that protect Greater Boston's communities, critical infrastructure, and regional economy.

Overly Impacted & Rarely Heard: Incorporating Community Voices into Massachusetts Energy Regulatory Processes

May 4, 2023

As the Commonwealth of Massachusetts decarbonizes its energy system, utility regulation and energy facility siting should be aligned with recent changes to legislation and policy. Given that this transition will include siting new infrastructure projects and other significant investments, decision-makers must consider the disproportionate impacts of energy-related burdens on environmental justice populations and appreciate the importance of providing opportunities for environmental justice populations to be involved in the development, implementation, and enforcement of environmental laws, regulations, and policies. The status quo provides environmental justice populations and impacted communities few or no meaningful opportunities to participate in agency proceedings, and few agency decisions reflect input from these populations. To address and remedy this systemic inequity, the Department of Public Utilities (DPU) and the independent Energy Facilities Siting Board (EFSB) must make significant changes to their regulatory processes. The changes should address how the agencies incorporate input from the public into decisions and how they facilitate, invite, and encourage the participation of environmental justice populations and impacted communities in proceedings. Agency decisions should equitably allocate environmental- and energy-related burdens and benefits and meaningfully integrate environmental justice principles into decision-making.This report includes recommended changes that the DPU and EFSB can implement in the short-term, as well as recommended changes that will take longer to implement. The Stakeholder Working Group (SWG) recognizes that some of the recommended changes may require increased budgets and staffing, as well as amending regulations and in some cases enacting new legislation. The SWG hopes that those at the state level and within the DPU and EFSB who have the authority to implement changes recognize the barriers identified and seriously consider the recommendations presented in this report. The SWG will endeavor to work collaboratively with the Executive Branch—including the Executive Office of Energy and Environmental Affairs (EEA) and the DPU and EFSB—to achieve more equitable decisions that better incorporate the input and interests of environmental justice populations.

Closing the Coverage Gaps: Reducing Health Insurance Disparities in Massachusetts

April 27, 2023

Massachusetts has been exemplary in developing health insurance coverage policies to cover its residents. By 2019, the state's uninsurance rate was 3.0 percent, the lowest rate in the nation, representing about 204,000 uninsured residents. While the state's overall uninsured rate at a given point in time is low, more than twice as many people - 503,000, or 7.3 percent of the population - experienced a gap in coverage over the previous twelve months. And importantly, not all groups benefit equally. People who are Black or Hispanic, or who have lower incomes, experience significantly higher rates of uninsurance than the state population overall. As a result, these groups are more likely to face access barriers and financial insecurity associated with being uninsured.The purpose of this report is to begin charting a course toward closing the coverage gaps in Massachusetts, with a particular focus on creating a more racially and ethnically equitable system of coverage. The report and accompanying infographics describe the people in Massachusetts without health insurance and the barriers to coverage they face, including affordability, administrative complexity, and immigration, language, and cultural barriers. It then proposes a menu of policy options that address the specific circumstances in Massachusetts. The proposed options are meant to inform a statewide conversation about the best approaches to closing the remaining coverage gaps in Massachusetts and removing structural barriers that result in racial and ethnic disparities in health insurance coverage.

Poll: More than three-quarters of Massachusetts residents support boosting funding for regional bus service

April 18, 2023

Results of a survey of 1401 Massachusetts residents, including 967 living in communities served by the state's 15 Regional Transit Authorities. The survey found majority support for increased funding for the RTAs. It also asked riders and non-riders about barriers to bus ridership and what factors would make the biggest differences in getting them to ride. The survey was conducted in collaboration with the Regional Transit Authority Advocates Coalition and was sponsored by the Barr Foundation.

Sustaining Art Research Collections: Case Studies in Collaboration

April 18, 2023

Art research collections continue to be impacted by the lingering effects of economic uncertainty and the global COVID-19 pandemic, which resulted in reduced or stagnant budgets and staffing cuts. These impacts have coincided with a period of institutional reflection and examination of the fundamental role of cultural heritage institutions in society. The case studies presented here illustrate how partnerships can support sustainability and growth, and they also share case study participants' generous insights into the lessons learned from their experiences. The report provides recommendations like conducting an upfront analysis of the benefits that a partnership will provide to each participant, understanding the core mission values that a potential partnership would support, and ensuring that the effort required to create and sustain a partnership aligns with the partnership's benefits. This timely report offers key insights into successful and sustainable collaborations for practitioners who may be facing immediate staffing, technology, or space needs and provides a framework that can guide future collaborations that not only meet basic needs, but also advance experimentation and innovation.

Great Migration to Global Immigration: A Profile of Black Boston

April 7, 2023

Symbolized by the unveiling of The Embrace - the memorial to Martin Luther King Jr., Coretta Scott King and dozens of other Boston civil rights leaders - new efforts have blossomed to help realize the unfulfilled promise of racial equity in our region. Recent political organizing has generated a new class of Black elected leadership. And the public discourse has shifted, with more people newly open to considering policy steps to repair past harms and build systems that are truly inclusive and welcoming. But there remains work to be done.With this backdrop, Great Migration to Global Immigration: A Profile of Black Boston analyzes the region's unique and growing intra-Black diversity, explores how the growing Black middle-class has helped revitalize cities and towns outside of Boston's inner core, and details how disparities by income and wealth manifest across Black communities.