With Love,
CtrlAltDel aka Dave
C4/5 Complete - 29 Years Post
Texas, USA
[EMAIL PROTECTED] wrote:
Interesting information about switching from Medicaid to Medicare.
Dana (C 4-5, 31 years post, 51, suburb of KC in Johnson County Kansas)????mip://0336a960/default.html ????mip://0336a960/default.html äQÃ?
Subject: The Fifth Step to Improving Prescription Drug Coverage
Sent: 7/28/2005 6:04 PM
Importance: Normal
Asclepios
Your Weekly Medicare Consumer Advocacy Update
ACT NOW: The Fifth Step to Improving Prescription Drug Coverage
July 28, 2005 ⢠Volume 5, Issue 30
Ouch!
As our national campaign to ensure a decent Medicare prescription drug benefit is gaining momentum, this week Asclepios tackles one of the most alarming problems in the Medicare drug benefit: the transition of people from Medicaid drug coverage to Medicare drug coverage.
Congress and the Centers for Medicare and Medicaid Services (CMS) are Pollyannasâthey seem to believe that 6.4 million of the sickest, poorest and most vulnerable people in this country can be seamlessly sw! itched from Medicaid drug coverage to Medicare drug coverage. This naïve notion means that there is no back up plan, no safety net for people who will fall through the cracks.
Imagine if you are Mrs. Jones, on six brand-name medications for a heart condition, diabetes and high blood pressure and only the ability to get to a local pharmacy to fill them. For years, she has done so easily with her Medicaid drug coverage. But come January 1, she finds that her local pharmacy is not part of the network of the drug plan to which she has been randomly assigned. How will she fill her prescriptions? Even if sheâs lucky and her pharmacy is in her drug plan network, she may well find that her plan does not cover three of the medications she depends on to make it through the day.
Or, she could find that as a result of a technical glitch, she has lost her Medicaid drug coverage and was never assigned a Medicare drug plan. Or, even if she w! as assigned properly, she may not know about it or understand what it means to her.
Itâs hard to imagine that even half of the people who are transferred from Medicaid to Medicare drug coverage will 1) understand their drug coverage has changed, 2) be able to access a pharmacy in their drug planâs network, and 3) be assigned to a plan that covers all their medications. Moreover, itâs inevitable that because of computer and human error, many people with Medicaid drug coverage will fall through the cracks in the transition to Medicare drug coverage.
A 50 percent success rate in the transition would mean that 3.2 million very sick and poor older adults and those with disabilities will abruptly lose the access to prescription medicine that they have today. And, they will likely have to wait to see their doctor if they need a change in their medication regimen to get coverage through their new drug plan. Or they may need to navi! gate an unfamiliar appeals process before they can obtain their life-saving and quality-of-life enhancing prescriptions. How many of those people will need to be hospitalized or visit an emergency room? How many people will die because they canât get their medicines?
Hereâs the fifth step to improving Medicareâs drug coverage:
5. Extend the availability of Medicaid drug coverage as backup drug coverage during a reasonable transition period to Part D.
At a Senate Special Committee on Aging hearing this spring, CMS Administrator Mark McClellan acknowledged looming problems for people who must move from Medicaid to Medicare drug coverage. Yet he helped Congress shirk responsibility for the impending humanitarian debacle and instead offered improbable solutions.
For example, Dr. McClellan suggested that state Medicaid programs âmay want to considerâ providing individual! s who are covered by Medicaid and Medicareâso-called âdual eligiblesââwith an extended supply (e.g., 60 or 90 days) of their prescriptions near the end of this calendar year.
This proposal shifts responsibility back to the states, which is not likely to happen for three reasons. First, state Medicaid budgets are strapped. Two, many states are not legally authorized to provide an extended supply of prescription drugs. And lastly, Dr. McClellan is proposing that states pay twice for prescription drugs. States would pay once in December 2005 for the extended supply that would buffer the transition, and then again in January and February 2006 through âclawbackâ payments they will make to the federal government to help finance the Part D benefit.
A real prescription drug benefit would make sure that no oneâparticularly vulnerable, poor people with chronic illnesses and disabilitiesâwould have to go without critical medications. No one would be the victim of bureaucratic error, a delay to comply with a plan formulary, inoperative pharmacy computers, or any other probable hitch.
Dr. McClellan and Congress are unrealistic about ensuring that the poorest and sickest Americans continue to get their prescriptions filled during the transition from Medicaid to Medicare drug coverageâeven when the solution is staring them in the face: extend the Medicaid safety net until we know that every âdual eligibleâ has successfully migrated from Medicaid drug coverage to Medicare Part D.
Sign up here to help build a national campaign to give people with Medicare the drug program they deserve.
Click here to send an e-mail message or letter telling us what worries you most about the Medicare prescription drug benefit and why creating a real Medicare drug benefit is important to you.
Medical Record
State ! Medicaid directors say that the timeframe for moving âdual eligiblesâ into Medicare drug plans poses major challenges. Some used the term âdisasterâ to describe the ambitious timetable and the likely outcome of its implementation. From their perspective as program administrators, participants indicated that the time allotted to get dual eligibles into private Medicare drug plans is not sufficient, even without accounting for the time dual eligibles would need to learn how to use the plans (âImplications of the Medicare Modernization Act for States: Observations from a Focus Group Discussion with Medicaid Directors,â Kaiser Commission on Medicaid and the Uninsured, January 2005).
People eligible for both Medicare and Medicaid (âdual eligiblesâ) are
Sicker. More than 50 percent of dual eligibles are limited in activities of daily living, and they have higher rates of Alzheimerâs disease, diabetes, pulmonary disease and stroke than other ! people with Medicare.
Cognitively impaired. Nearly 4 in 10 have a mental or cognitive impairment. That means that 2.5 million dual eligibles may not be able to navigate program changes even if education and communication efforts are appropriately implemented for an older population.
Underserved. More than 40 percent of dual eligibles are racial/ethnic minorities, and âdual eligiblesâ are more likely to live in rural areas than other people with Medicare.
Institutionalized. One in four dual eligibles lives in a nursing home or other long-term care facility.
(âReport to the Congress: New Approaches in Medicare,â Medicare Payment Advisory Commission, June 2004.)
The dual eligibles have about a 10-week window to enroll in the Medicare drug benefit before losing their Medicaid prescription coverage, but much more time is needed to ensure a successful transition. The Medicare Payment Advisory Commission (MedPAC), an independent ! federal body that advises Congress on Medicare issues, notes that accomplishing the task of transitioning people from one drug plan to another in the private sector takes a minimum of six, and preferably, nine months (âReport to the Congress: New Approaches in Medicare,â Medicare Payment Advisory Commission, June 2004).
â[W]e anticipate that there is a potential for a high volume of beneficiaries, and providers on their behalf, needing to file exceptions or needing alternative prescriptions on a short-turnaround basis after inception of the new Medicare drug benefit on January 1, 2006â (âInformation for Part D Sponsors on Requirements for a Transition Process,â Center for Medicare and Medicaid Services, March 16, 2005).
Fast Relief: What You Can Do
Let everyoneâyour colleagues, friends, familiesâknow how we can improve the Medicare prescription drug benefit for people with Medicare and American taxpayers. Help us build a ! national network of concerned citizens who want to create the Medicare prescription drug benefit Americans deserve.
Click hereto help build a national campaign for a real Medicare prescription drug benefit!
*****
Donât Let Your Suffering Go Unnoticed
Are you struggling to pay for your prescriptions drugs or get the health care you need? Work with the Medicare Rights Center to bring your story to the ears of policymakers, the press and the public in an effort to expose the shortcomings of the American health care system. To learn more about how to make your voice heard in the national Medicare debate, visit www.medicarerights.org/maincontenthiddenlives.html
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Asclepiosânamed for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greeceâis a weekly action alert designed to keep you up-to-date with Medicare program and! policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. A national nonprofit founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
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