|
Promoting enrollment for
three of the Medicare Savings Programs run by state welfare
offices to pay Medicare premiums and some other cost-sharing for
limited-income Medicare
patients who are slightly "too rich" for full, regular Medicaid---QMB,
SLMB and QI---can now
also ease access to $600 yearly of drugs through the Medicare Prescription
Drug
Discount Card Interim Assistance Program during 2004 and 2005---and,
beginning
January 1, 2006, to comprehensive, premium-free, no-deductible,
low- copay
enrollment in a permanent Medicare prescription drug plan (with no
"donut hole" of
non-coverage).
The Centers for Medicare and Medicaid Services (CMS), with
state Medicaid agencies,
has already arranged to have interim drug discount card sponsors enroll QMB,
SLMB and
QI eligibles (if they're not
also on full, regular
Medicaid too) in a Medicare
Prescription
Drug Discount Card Interim Assistance Program of each patient's choice for
2004 and
2005---and, beginning January 1, 2006, in a permanent,
comprehensive,
premium-free,
no deductible,
low copay Medicare prescription drug plan of each patient's choice (with
no "donut hole"), even if they
are
also on
full, regular
Medicaid too.
It's therefore important
that state ADAP and senior pharmacy assistance programs at
once begin to identify those of their
current recipients---as
well as new applicants
---who are on Medicare and have incomes under 135% of poverty (in 2004,
$1068
monthly for one person; $1425 for two--adding on the $20 income
disregard used by
QMB, SLMB and QI) and with modest assets*.
Such clients now can be
referred to
state welfare offices to apply for QMB, SLMB and QI ---which will thereby
facilitate their
enrollment for the above-described
federal
Medicare prescription drug plans, which
can significantly reduce the hard-pressed states' ADAP and senior pharmacy
assistance costs.
And
in late 2005, all Medicare patients with
incomes under 150% (in 2004, that's
$1184 monthly for one person and $1582 for two), and with slightly higher
modest
assets*,
will also
be eligible to enroll (through Medicare drug plan sponsors, welfare
offices and possibly Social Security offices) for coverage beginning January
1, 2006
|in a permanent, comprehensive, very
low premium, very low
deductible, low copay
Medicare prescription drug plan
(with no "donut hole") of each patient's choice. State
ADAPs and senior prescription assistance programs now can also
begin identifying
this
class of recipients and applicants to refer them in time to welfare offices
for
permanent Medicare prescription plan enrollment in late 2005, which will
also reduce
state costs.
State ADAPs and senior
pharmacy assistance programs can assure themselves that
referred clients are,in fact, utilizing the federal $600 interim assistance
prescription
allowance by requesting clients' Explanation of Benefits (EOB) forms---or,
if EOBs are
unavailable, printouts of their allowance balances. CMS' interim final
regulations for the
Medicare Prescription Drug Discount Card and Interim Assistance Program,
published
December 15, 2003 at
www.federalregister.gov , state in their preamble that "As
required under Section 1860D-31(d)(2)(C) of the Act, ..[Discount Card
Interim
Assistance Program contractors must].. make available electronically or by
telephone
at the point-of-sale of covered discount cards the amount of transitional
assistance
remaining on balance to the transitional assistance enrollee....[Discount
Card contractors]
must also include information in the member handbook or summary of program
features
on how an enrollee can obtain his or her transitional assistance
balance...."
State senior pharmacy
assistance programs’ claims processing contractors, if qualified,
can actually sign up as Discount Card contractors---and thus, among other
things, help
defray part or all of interim program enrollees' 5% or 10% coinsurance. But
even if they
don't, but still want to assist interim enrollees with the coinsurance,
Section II.H of the
preamble explains that they may arrange to pay it for enrollees directly to
the Interim
Discount Card plans. The preamble further assures states which may
be concerned
about needy clients' ability to pay the 5% and 10% coinsurance for the
interim $600
discount cards in 2004 and 2005 that participating pharmacies won't be
penalized for
waiving the coinsurance for needy patients after good faith collection
attempts, if such
waivers are not advertised and not routine. (However, copayments and
coinsurance due
under the permanent Medicare prescription plans after January 1,
2006 must always
be collected from enrollees unless state
pharmacy assistance programs--but not
Medicaid-- rrange to defray them as state-option "wraparound" coverage.)
Enrollment in QMB,
SLMB and QI now can help bring $600-a-year of free prescriptions
through the Interim Assistance Discount Card Program in 2004 and 2005 as
well as
permanent, comprehensive,
no-deductible, premium-free, low copay Medicare drug plan
coverage beginning January 1, 2006. This can result in greatly decreased
state ADAP
and senior pharmacy assistance expenses. Pennsylvania, for example, will
save $150
million in state dollars in 2004 and 2005 by seeing to it that its PACE
(state
senior pharmacy assistance) recipients fully exhaust their Medicare Interim
Drug Discount
Card $600 benefits before tapping state funds for prescriptions. For
details, see
http://www.post-gazette.com/pg/04117/306748.stm
.
*
$10,000 per person, $20,000 for two, plus a lived-in home and
one vehicle of any |value, household goods
and $1500 per person in a separate, designated "burial" account. The QMB,
SLMB and QI allowed assets
are the same, except that the dollar amounts are only $4,000 for singles and
$6,000 for couples
 Section L: Stop Wasteful, Ineffective Red Tape (Particularly Asset
Tests) to Economically
Streamline Eligibility Determination Administrative
Costs for S-CHIP and Medicaid for
Children and Parents.
|
“Painless”
Administrative Ways For States With Budget Shortfalls to Preserve or
Increase Medicaid and S-CHIP Program Funding
Section K
HTML ©AIDS Drug Assistance
Protocol Fund |
|
