Urge Congress to Provide Safety Net for Most Vulnerable Americans
January 27, 2005

The Medicare Rights Center is launching an online action center to ensure your voice is heard on important Medicare consumer issues. Visit it and send a letter to your representatives and senators today! Last week, the Centers for Medicare and Medicaid Services (CMS) released the final regulations to implement the 2006 Medicare Drug Benefit.

The Medicare Rights Center is encouraged that the Bush Administration recognizes the grave risk 6.4 million poor Americans dually eligible for Medicare and Medicaid will face when their prescription drug coverage under Medicaid ends on December 31, 2005. It is a train wreck waiting to happen.

We are dismayed, however, that the regulations do little to avoid the humanitarian debacle that faces the poorest and sickest Americans, many of whom will lose their access to the medicines they need. The systems are not, and will not, be in place to maintain consistent drug coverage for the most vulnerable Americans.

The administration’s steps to move up enrollment of the poorest older adults and people with disabilities into Medicare drug coverage are welcome but inadequate. They do not address the reality: Medicaid must temporarily continue for people whose Medicare drug plans cannot be verified at the time they buy their medications. CMS must require Medicare drug plans to offer open formularies or honor Medicaid program formularies and pharmacy network agreements through 2006.

Otherwise, millions of Americans in great need will face needless illness, suffering and a greater risk of premature death. They will be among the men and women left worse off by the 2003 Medicare legislation. The 1,162 pages of regulations cover hundreds of issues and require careful review. We are pleased with some of the changes we have seen and disappointed by the absence of others.

One point jumps out: the administration’s failure to address realistically the human misery that awaits poor Americans next January will threaten the health of millions of men and women, and will haunt all people who recognize the moral value of health care for our neighbors in need.

Because CMS deems it beyond its authority to extend Medicaid prescription drug coverage temporarily, we must call on our senators and representatives in Congress to work toward implementing a legislative change, relatively small, but with a huge positive impact for millions of the most vulnerable Americans – the poorest older adults and people with disabilities. Click the online action center to send a letter right away.

Medical Record

To be eligible for Medicaid, you typically have to have an income below the Federal Poverty Level (FPL) and very limited assets. The FPL was $ 9,310 in 2004; 2005 figures will be released in the spring.

Older adults fill on average 25.5 prescriptions a year (“ Retail Prescriptions Filled Per Capita by Age, 2003,” Kaiser Family Foundation State Health Facts).

People dually eligible for Medicare and Medicaid (“dual eligibles”) are:

• Sicker. More than 50 percent of dual eligibles are limited in activities of daily living, and they have higher rates of Alzheimer’s 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 elderly population.
• Underserved. More than 40 percent of dual eligibles are racial/ethnic minorities, and dual eligibles 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. (“Report to the Congress: New Approaches in Medicare,” Medicare Payment Advisory Commission, June 2004.)

The amount of time allocated for the switch from Medicaid drug coverage to Medicare drug coverage for dual eligible individuals is not enough to ensure a smooth transition. Even though dual eligibles will have several more weeks than the original six-week window to enroll in the Medicare drug benefit before losing their Medicaid prescription coverage, 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 tasks of transitioning people from one drug plan to another in the private sector takes a minimum of six, and preferably, nine months (“Report to the Congress: New Approaches in Medicare,” Medicare Payment Advisory Commission, June 2004).

Automatic enrollment may prove essential, but also problematic because

• Reaching, informing and enrolling all dual eligibles by January 1, 2006, pose serious challenges;
• Dual eligibles may be confused or unaware that they have been automatically enrolled;
• Dual eligibles may end up in plans that do not cover the medications that were previously covered under Medicaid or with a drug plan that is not accepted at their pharmacy. (“The New Medicare Prescription Drug Law: Issues for Enrolling Dual Eligibles into Drug Plans,” prepared by Richard Jensen for the Kaiser Commission on Medicaid and the Uninsured, January 2005.)

Less than a third of eligible persons are enrolled in Medicare Savings Programs, which can help pay for their Medicare premiums, deductibles and coinsurance (“ A Detailed Description of CBO’s Cost Estimate for the Medicare Prescription Drug Benefit,” Congressional Budget Office, July 2004).

Fast Relief: What You Can Do

Tell your senators and representatives that they need to act quickly to ensure a successful transition from Medicaid drug coverage to Medicare drug coverage for the poorest older adults and people with disabilities. To prevent vulnerable people from experiencing gaps in treatment for debilitating conditions such as diabetes, heart disease osteoporosis and mental illness, Congress must work to extend Medicaid as a temporary safety net. Too many people’s health and lives are at stake.

Visit MRC’s new online action center where you can send a letter to your representatives in a few simple steps.

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