Medicare is scheduled to start covering prescription drugs January 1 next year. The program is proving so highly complicated and untested, however, that many senior advocates (including TSCL) believe there may be chaos come January 1 unless the government moves quickly to make changes. Concerns are growing that there will be widespread confusion among Medicare beneficiaries and the high risk for disruptions in access to needed drugs.
Among many other things, the new Medicare drug law eliminates Medicaid drug coverage for 6.4 million "dual eligibles" — persons who receive benefits from both Medicare and Medicaid — and automatically moves them to Medicare drug coverage on January 1, 2006. Beneficiaries who currently receive their drugs through state Medicaid programs, including many of the residents of the nation's nursing homes, are supposed to receive their drugs under Medicare starting January 1.
Seniors who formerly received their drug benefits under Medicaid will be automatically accepted for additional financial assistance under Medicare and will be assigned a drug plan chosen at random. Senior advocates and doctors are increasingly warning that care may be disrupted, nevertheless. According to the Medicare Rights Center (MRC) a national consumer service organization, "Even if there was a 99% success rate in the transition — a rate that no one, including the Centers for Medicare and Medicaid Services (CMS) leadership thinks is achievable —64,000 of the poorest and sickest Americans will lose their existing drug coverage on January 1, 2006."
"We're extremely concerned about the complexity of the new Medicare drug benefit," says Tom Frazier, Executive Director of the Coalition of Wisconsin Aging Groups and a member of the Medicare Rights Center's Consumer Action Board. "Even though there will be automatic enrollment for dual eligibles, we feel the potential is great for some seniors to fall through the cracks."
Because drug plans will be able to vary the drugs they cover, doctors and advocates are concerned that beneficiaries may be assigned to plans that may not cover all the prescriptions that they need. Although they will be able to switch plans, because the Medicaid drug coverage ends on the first day that the Medicare drug coverage becomes effective, "the transition leaves no margin for error in moving millions of the frailest older adults from Medicaid to Medicare Part D," says a recent report from MRC.
MRC recommends, and TSCL agrees, that to ensure the safe and smooth transition of individuals with Medicaid drug coverage to Medicare Part D benefit, Congress should extend the Medicaid coverage as a safety net for a reasonable transition period. Maintaining Medicaid coverage would protect people who will lose their Medicaid coverage, but are not enrolled in a Part D plan because of a transition error, or who have not received notice of their plan assignment, or who do not know how to obtain medications using their Part D Plan. It would also protect those who must be transferred to and stabilized on new prescriptions to comply with their new Part D coverage.
To learn more about the Medicare Rights Center and to read "101 Q and A's About the New Drug Benefit" visit online at www.medicarerights.org.
Sources: "News From the Trenches: Consumers Speak Out On Medicare Needs," Medicare Rights Center, May 2005. "Extend Medicaid for the Most Vulnerable," Asclepios Newsletter Volume5#11, Medicare Rights Center, March 17, 2005.
June 2005
