SENATE HEALTH COMMITTEE APPROVES EXTENSION OF EMERGENCY PRESCRIPTION DRUG COVERAGE FOR MEDICARE PART D PROBLEMS

  • Emergency coverage expires May 16th; AB813(Perata/Nunez) would extend “last resort” drug coverage for low-income seniors and people with disabilities; Length of extension disputed.
  • Congress urged to extend deadline for seniors who have not yet chosen a prescription drug plan.
  • Federal funds for medical interpreter services sought.
  • Action Item: Advocacy needed on Medicare emergency coverage, co-payments coverage

The next few days feature a series of key days and deadlines for the seniors and people with disabilities, impacting their ability to get the drugs they need, through the Medicare Part D program.

  • On Friday, May 12th, the Governor will release the “May Revise” of the state budget, where he will announce if he supports the state covering the newly-imposed co-payments on one million low-income seniors and people with disabilities.
  • Monday, May 15th is the last day that seniors and people with disabilities can sign up for a Part D prescription drug plan before facing a lifetime penalty. About 1 million low-income seniors and people with disabilities in California are dually eligible for Medicare.
  • And Tuesday, May 16th is when the California’s emergency “safety-net” coverage program will expire, if the legislature does take quick action in the next few days. This “coverage of last resort” was instituted with bipartisan support, in response to major failures in the implementation of Part D, to ensure that low-income seniors and people with disabilities that were automatically enrolled in the program continued to get needed medications. The problems were plentiful: Some patients could not be found in the system, others were paying exorbitant co-pays. The state initially approved this emergency coverage in January, allowing for up to $150 million to cover these costs. The state covered hundreds of thousands of drugs, which was reimbursed by the federal government through March. Since then, around $20 million has been spent.

This past Wednesday, the Senate Health Committee heard a handful of bills, but the one that got the most attention was the debate about whether to extend this emergency coverage, and how to do it.

EMERGENCY COVERAGE EXTENSION CONSIDERED

AB813 by Senate President Pro Tem Don Perata and Assembly Speaker Fabian Nunez would extend this emergency coverage through March 31, 2007. The ten month extension is intended to give the government and insurers time to sort out problems for this vulnerable “dual-eligible” population, which uses an average of at least ten prescription drugs a month, according to some estimates. The extension would allow this “coverage of last resort” to be in place during the transition to the second year of the program, when many prescription drug plans are expected to change their formularies or pull out of the market altogether, causing confusion and potential problems.

All Democrats on the Senate Health Committee, chaired by Sen. Deborah Ortiz, voted in favor of the measure. The measure got testimony in support from a wide range of representatives of seniors, consumers, low-income families, health groups, pharmacists, retailers, people with disabilities, medical providers, communities of color, and other organizations. There was no organized opposition.

Senate Republicans abstained, and noted that they had concerns, especially about the length of the extension. The reason, they said, is that the state should not be in the business of dealing with “federal issues.” This development does raise alarms: the bill will need Republican votes in order to get the two-thirds votes needed to pass in the next few days as an emergency measure.
California has one million low-income seniors and people with disabilities that are under both Medicare and Medi-Cal, which account for over 14 percent of the “dual eligibles” in the country. Even as the problems have lessened, the emergency programs still pays for thousands of prescriptions a day, that without this program, many of which would either go unfilled, or place a financial burden on this low-income and frail population.

ACTION NEEDED: Legislators from both parties need to be urged to protect these dual-eligible seniors and people with disabilities, to ensure that they get the drugs they need. Health advocates are urging their memebers and allies to call their Assemblymembers and Senators to:

  • Support AB813 (Perata/Nunez) to allow the state to continue emergency drug coverage for seniors and persons with disabilities so they get needed prescription drugs when Medicare Part D fails, including for the expected problems and prescription drug plan changes at the beginning of 2007.
  • Support a budget item that has the state, in the budget prcess, agree to cover the newly imposed co-payments for low income senior and disabled people living on fixed incomes, so they are not worse off than they were last year.

STATE APPEALS TO CONGRESS FOR DEADLINE DELAY

The Senate Health Committee also took up other issues, including another Medicare Part D issue. Democrats on the committee also approved AJR 40 by Assemblywoman Wilma Chan, a resolution to urge Congress to allow seniors extra time to make adjustments to and enroll in a Medicare Part D prescription drug plan.

The cut-off date for seniors and people with disabilities to decide on whether to enroll in the federal program and select a plan is Monday, May 15th. There is a 1% surcharge added each month to the premium for those who do not select a plan before May 15. Consumers who miss the deadline cannot then sign up until November with coverage beginning in January 2007. Legislation, such as H.R. 3861(Stark) is pending to extent this deadline, and the Bush Administration has such authority for “exceptional circumstances.”

The problem is manifold. First, the calamitous start to Medicare Part D has discouraged the enrollment of many seniors. Additionally, materials remain complicated and confusing, and recent surveys found Medicare’s website and toll-free line to provide inaccurate, incomplete, or inappropriate information. In California, there are 47 different stand alone Medicare prescription drug plans.

Therefore, AJR40 urges Congress to amend the Part D program so that seniors not be punished for the federal government-wrought confusion.

Rather:

  • The deadline for enrolling in a program should be extended to December 31, 2006.
  • Medicare beneficiaries should be allowed to change plans once in 2006 without penalty if they feel they’ve made a poor decision.
  • Retirees with health benefits should not lose them because they signed up for Medicare Part D.
  • Legislation, such as H.R. 3861(Stark), is pending in Congress to extend this deadline and take these actions. The Bush Administration has such “exceptional circumstances” authority to make these changes. At this point, it has not chosen to do so.

LANGUAGE ACCESS DISCUSSED

On another important topic, the Senate Health Committee approved SB1405 (Soto), which would require the state to set up a task force to actively seek federal matching funds to pay for medical interpretation services. The bill is co-sponsored by the Asian Pacific Islander American Health Forum, the California Pan-Ethnic Health Network, the California Primary Care Association, and the Latino Coalition for a Healthy California.

California has both the largest number and highest percentage of immgrants of any state in the nation. Census data estimates that 25 percent of the California population is foreign born. Twenty percent of the state’s population has limited English proficiency. That makes visiting the physician to explain ailments, or even for routine checkups, an extremely intimidating process.
Children are used as interpreters. Cultural barriers prevent parents from explaining to their children intimate and embarrassing details of their ailments. Or, a visit is reduced to a game of pointing and charades.

In 2003, SB853 (Escutia) required the Department of Managed Health Care to establish standards for health plans to provide enrollees with language assistance. Those regulations are currently pending at the Department of Managed Health Care.

However, providers and advocates argue that money is needed to provide adequate interpreter services by people trained in the appropriate medical . The bill begins to explore an important solution to ensure the health of California ’s communities.

Health Access California promotes quality, affordable health care for all Californians.

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