Full
implementation of the Medicare prescription drug program
is making people nervous.
Those who rely on Medicaid for their prescriptions
are facing quite a bit of paperwork to make sure they
receive their medications. Those with "dual
eligibility" - meaning people qualified for
Medicare Part D and Medicaid drug coverage - have
several steps to take to ensure coverage.
In April, the Center for Medicare and Medicaid
Services accepted prescription drug plans and Medicare
Advantage prescription drug plan formularies to provide
drug benefits in 2006.
Now comes the work of enrolling low-income
recipients. The Social Security Administration is
sending out notices to 20 million Medicare beneficiaries
- half of all Medicare beneficiaries - informing them of
the low-income subsidy for premium and co-payment
assistance. The mailing also will include an application
form for the subsidy. Beneficiaries may complete and
submit the form for future evaluation by the Social
Security Administration or their state Medicaid agency.
I've been receiving e-mails since May concerned about
the bigger hurdles of the Medicare drug program. Many
recipients want to know what happens when a drug is not
covered under Part D but is covered under Medicaid and
if the co-payment for the drug will be counted as a
"true out-of-pocket" expense under Medicare
Part D, for purposes of meeting the eligibility limit
for catastrophic coverage.
That's just one question.
Then there are the recipients who get their
medications filled on a 60- to 90-day program and whose
refills are due in December. Will Medicaid be reimbursed
for medications used after Jan. 1, or will the state
have to absorb the entire cost?
The National Mental Health Association has issued a
four-page commentary titled "Key Questions:
Transition to Medicare Part D." The document talks
about what will be done with dual-eligibility coverage
and gaps in premiums and with the states using savings
in their state pharmacy assistance programs to cover
populations not eligible for the Part D benefit - for
example, uninsured individuals who are not seniors,
disabled people in the two-year waiting period before
they are eligible for Medicare and many more.
The report states: "Final rules from the Center
for Medicare and Medicaid Services were released in
February and, despite the possibility of further
guidance documents from Center for Medicare and Medicaid
Services, the implementation timeline and the details of
plan design are set. It is clear that states bear a
significant administrative responsibility in
implementing Medicare Part D. Center for Medicare and
Medicaid Services recently identified activities under
way to assist states with preparation, including
creation of a 'state legislators' checklist' to provide
instruction on how the transition of full-benefit dual
eligibles will occur".
The Social Security Administration and the Center for
Medicare and Medicaid Services say they are committed to
make the transition as smooth as possible, acknowledging
changes will occur during the process.
Thankfully, agencies are gearing up for the
transition to Medicare Part D.
Hang on - it will be a bumpy ride.
You can e-mail Barbara J. McKee at chairgrrl@chairgrrl.com.
Her column runs on Tuesdays.
