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Brainstorming to Give Impoverished Seniors Prescription Drug Help

By John Reichard, CQ HealthBeat Editor

May 16, 2008 -- Federal officials met with representatives of community and senior organizations at a "summit" Friday to improve efforts to sign up seniors for Medicare's relatively generous prescription drug benefit for low-income seniors.

As part of the effort, Acting Centers for Medicare and Medicaid Services Administrator Kerry Weems said he'll hold regional CMS administrators' feet to the fire by establishing and publicizing enrollment goals for each of their regions. "We are not kidding about reaching everybody," he said.

Weems estimated that more than 80 percent of those eligible for the benefit, better known in bureaucratic lingo as the "low-income subsidy," or "LIS" have been enrolled. "This is a major achievement. You should be proud of it," he told summit participants. "This work isn't easy. It's like looking for a needle in a haystack.

Last year working together we successfully increased the number of low-income subsidy individuals by a quarter of a million people," Weems continued. "However, I think you'll agree that these people were the low-hanging fruit...we want to climb higher in the tree and reach the upper branches.

"Listening to you, CMS has refined our national campaign," Weems added. The campaign dropped a late-enrollment penalty and allows those eligible for LIS to enroll at any time during the year. The agency also has commissioned new research "that will measure the effectiveness of multiple direct marketing approaches."

A particular focus of Friday's gathering was targeting data pointing to areas of the country that could clearly benefit from—increased, intensified, targeted outreach. Some of these are places you'd assume outreach would be necessary—Cook County [Illinois], Kings County New York [Brooklyn], Los Angeles, Philadelphia, but there are others. Rural Louisiana, Arkansas, Kentucky, Tennessee "these aren't necessarily places that people think of first."

Much of the summit was to be devoted to the sharing of lessons learned among the organizations partnering with CMS. Agency officials also went over data that could be used to identify the best outreach targets. That information includes rankings of counties according to estimated numbers of beneficiaries eligible for the low-income drug benefit. The data allows groups to identify counties that have large numbers of those beneficiaries—or if not large numbers, relatively large percentages of Medicare beneficiaries falling into the low-income category. The data also allows analysis of individual zip codes to find where those eligible are clustered.

Reaching households is one thing, persuading people to sign up is another.

Research released by CMS at the meeting sought to shed more light on why those eligible for LIS have not enrolled. Interviews with selected numbers of that population found that in many cases they are in good health, do not expect to need prescription drugs for several years, and that they have heard prescription drug costs are high under the Medicare drug benefit.

Seniors also were reluctant to provide personal information on the application filed with the Social Security Administration to determine if they had too many assets to qualify. "A strong sense of pride and desire for independence is a barrier" in rural areas, researchers found. "Some equate it to asking for a handout," or getting welfare and fear being stigmatized in their communities.

In other cases, people have little experience calling CMS or the Social Security Administration and are intimidated by the prospect. In urban areas, seniors appear to be more connected socially, but to have fewer ties to senior groups and senior centers than in rural areas.

"Partners believe the key to successful outreach initiatives have been one-on-one contact," particularly in settings such as drug stores, libraries, health fairs, and senior centers. Partners also "strongly encourage partnerships with churches." Church leaders "are some of the most respected individuals in the communities and carry significant weight with those who might be too proud to accept help."

In rural areas, seniors express "greater reliance on in-person resources such as local insurance agents, trusting them with all types of financial and insurance decisions," researchers added.

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