Medicare prescription plan off to rocky start
A few passing clouds might have been anticipated, but neither the states nor the federal government were ready for the hailstorm of administrative problems that erupted when a new Medicare program went into effect on Jan. 1. The Part D program, designed to move millions of low-income elderly and disabled Americans from state-sponsored prescription drug care to a federal Medicare drug plan, has been riddled with bureaucratic problems.
The sheer volume of people signing up for the various plans overloaded Medicare computers, leaving pharmacists unable to confirm patient eligibility. To further complicate the problem, the federally subsidized program is administered by commercial insurance companies, some of which are unclear on what they will cover.
Hardest hit are the 6.5 million people eligible for both Medicare and Medicaid, whose Medicaid coverage ended Dec. 31, 2005. Those who did not elect a drug coverage plan under Medicare Part D were automatically enrolled in a plan. In some cases, the results were nightmarish. “I had a client who had to borrow $200 in order to get a few of his vital medications because he was being charged $189, when his co-payment should have been $3,” says Cheryl Meronk of the Orange County, Calif., Council on Aging, one of several organizations that helps limited-income residents navigate the new Medicare drug plans. “We have had others [who] have been hospitalized due to not taking their medication because they ran out and couldn’t get them.”
At least 32 states enacted emergency legislation to assist vulnerable residents who could not afford their medications. As of Jan. 18, the Minnesota Department of Human Services paid pharmacists for 38,000 claims amounting to $2.2 million for residents who were incorrectly denied coverage for their medications. By Jan. 27, Arkansas had incurred $3.7 million in similar costs, and by Jan. 30, California owed $14.5 million worth of pharmacist claims.
On Jan. 19, a bipartisan legislative group led by Senators Frank Lautenberg, D-N.J., and Olympia Snowe, R-Maine, announced emergency measures that demanded the federal government reimburse states with interest for the millions of dollars they paid for the low-income and disabled beneficiaries caught up in the Medicare mess. The legislation directs the Secretary of Health and Human Services to recover overpayments states have made to private prescription drug plans, returning the money to the Medicare Trust Fund.
“The governor has been very clear he expects the state to be fully reimbursed,” says California’s Deputy Director for Medical Care Services, Stan Rosenstein, who headed the reimbursement negotiations for the state with the Washington-based Centers for Medicare and Medicaid Services (CMS). Rosenstein says both state and federal governments need to work on a number of issues to get the program running correctly. “It’s a work in progress,” he says.
It appears that Medicare’s darker clouds may be parting, though. Since introducing the bill, Department of Health and Human Services Secretary Michael Leavitt and CMS Administrator Mark McClellan have acted quickly to ensure that states will not shoulder the costs, says Luke Friedrich, Minnesota Press Secretary for Senator Norm Coleman, an original co-sponsor of the legislation. “We’re keeping [the bill] in the hopper until we’re 100 percent [certain] the states have been properly reimbursed. But it appears so far that the reimbursement plan the secretary and CMS administrator have come up with seems to be working,” Friedrich says.
Annie Gentile is a Vernon, Conn.-based freelance writer.