Thu, 19 Oct 2006 22:49:20 EDT
632,000 risk loss of drug benefit
Many cut from Medicaid won't know they need to enroll in Medicare, advocates say
Associated Press
Originally published October 19, 2006
WASHINGTON // The federal government has told about 632,000 elderly and disabled people they won't be automatically enrolled in a Medicare drug plan next year.
Those people are still eligible to participate in the drug benefit, but they will have to shop for a plan and enroll on their own, rather than the government doing it for them. To afford the benefit, many will also need to apply for low-income subsidies.
Some advocates are concerned that many of the 632,000 could fall through the cracks, not knowing that they don't have coverage for their medicines until they go to their pharmacies in January.
"We're very concerned," said James P. Firman, president and chief executive of the National Council on Aging. "We believe many, if not most of the people, simply won't respond to a letter. Many won't read the letter, they won't understand the letter, they won't know how to fill out the application form."
During the first year of the drug benefit, the "dual eligibles" were automatically enrolled because they participated in Medicaid and Medicare and were the sickest and most vulnerable among the elderly and disabled. The federal government wanted to ensure that they did not lose access to prescription drugs.
States have informed the federal government that some of those beneficiaries no longer are enrolled in their Medicaid programs, so they will no longer be automatically enrolled in a drug plan.
The Centers for Medicare and Medicaid Services recognizes that some in the group might fail to sign up for a drug plan during the next open enrollment period, Nov. 15 though Dec. 31.
The agency has granted the group an extra three months to enroll in a plan without the prospect of a penalty for late enrollment, said Kathleen Harrington, director of external affairs for the agency.
Harrington said people in the group were told in the letter last month that they should apply for the low-income subsidy, which could give them access to a drug plan with small or no monthly premiums. She also said that the insurers themselves have been told who will need to apply on their own.
"It's very much in the interest of the plans to keep them in coverage," Harrington said.
Firman has worked closely with federal officials to enroll low-income seniors in the drug benefit. He has not been critical of the program, so his qualms cannot be dismissed as criticism from an outspoken opponent.
The beneficiaries he is concerned about qualify for Medicare because of age or disability. They also previously had qualified for Medicaid because of their incomes.
In some cases, people who lost their Medicaid coverage may have lost eligibility because they're making more money and no longer qualify for the extra help.
"But it's more likely that some states tightened eligibility requirements, or the individual did not complete all the paperwork needed to be re-certified for Medicaid," Firman said.
Firman said his organization's experience in reaching out to low-income seniors is that about 20 percent will respond to a letter.
"We're talking about a population that's sick, may have low literacy. There are a lot of challenges," he said. "What they need is one-on-one assistance from trusted intermediaries."
Firman said he hoped that insurers would take some follow-up steps, too.
"We believe the plans themselves should have responsibility for helping their customers do this. It also makes good business sense because they could lose these customers," he said.
Harrington said there are no plans to follow the letter with calls, but advocacy groups and other government agencies will make outreach efforts in communities that have large numbers of seniors eligible for the low-income subsidy.
