Drug coverage under state Medicaid programs recently ended for six million of the nation’s poorest Medicare beneficiaries.  Instead, these seniors, including a majority of the residents of nursing homes, are now supposed to receive their drugs through private Part D drug plans.  Known as "dual-eligibles" because their incomes qualify them for both Medicaid and Medicare, the federal government automatically enrolled them in Part D drug plans. 

Tens of thousands of these seniors in virtually every state either had to pay the cost  of their drugs out-of-pocket or go without in January,  when the new program was beset with widespread implementation problems.  Because Medicare does not require drug plans to cover every drug, many seniors learned they were assigned to drug plans that didn't cover all their medications.  Pharmacists had problems confirming eligiblity or what drug plan individuals were assigned to.  Although rules allow beneficiaries to switch plans, it may take several months to correct all the problems.

The transition plans put in place by the Centers for Medicare and Medicaid Services left no margin for error.  In 2005 TSCL was among numerous senior advocacy organizations that called on Congress to ensure that plans to transfer low-income beneficiaries from state Medicaid drug programs to Medicare would not disrupt access to life giving medications.  TSCL is continuing to press Congress to provide the oversight the program has sadly lacked.

Sources: "MRC Suit Seeks Extension of Medicaid Drug Coverage for Dual Eligibles," Medicare Watch Vol. 8, No.25, December 6, 2005. "Government Announces More Medicare Safeguards," Kevin Freking, The Associated Press, December 1, 2005.

February 2006