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Medicare Panel Discussion Focuses on Effect of Drug Benefit on Dual Eligibles

MAY 16, 2005 -- Audience members at a Monday panel discussion about the new Medicare drug law expressed concern that those enrolled in both Medicare and Medicaid will not make a smooth transition when the new drug benefit goes into effect in January.

The prescription drug benefit, or Part D of the Medicare program, was created as part of the Medicare drug law (PL 108-173).

While enrollment is optional, those eligible for both Medicaid and Medicare will have their drugs covered by Medicare once the drug benefit begins next Jan. 1. Some health care analysts fear that these "dual eligibles" could be hurt by the transition.

Congressional aides and representatives from various health organizations directed questions at panelists Tricia Neuman, vice president of the Kaiser Family Foundation, Linda Fishman, director of Centers for Medicare and Medicaid Services' (CMS) Office of Legislation, and William Scanlon, a senior policy advisor with Health Policy R&D. The Alliance for Health Reform and the Kaiser Family Foundation co-sponsored the event.

Neuman said that those with dual memberships will be contacted by the end of the year about the change in Medicare, either through CMS or their state government. She added that they will be assigned a plan under Part D to ensure that coverage continues through the transition, but they can change this to cater to their specific prescription drug needs.

"The worry is that not all seven million people will make this transition smoothly," Neuman said. "A lot needs to be done to make sure that there aren't any gaps and make sure no one falls through the cracks."

Neuman said that both the Kaiser Family Foundation and CMS are projecting roughly 29 million of the 40 million Americans on Medicare will enroll in Part D by January.

"The issue of participation is very important," she said.

Enrollment will be key to the success or failure of the new drug benefit. Scanlon said he was concerned about outreach initiatives thus far.

"We're talking about the entire Medicare beneficiary population," he said. "It is going to be very important that the word get out to the beneficiaries so we can achieve these levels."

Fishman agreed with Scanlon and said that CMS has been focusing on letting people know about the new benefit throughout the year.

"Outreach is what CMS is all about," Fishman said.

The discussion also focused on how low-income participants would fare under the new drug benefit. Individuals dependent on food stamps and other federal government benefits could lose them if they opt to enroll in Part D.

"This benefit is so generous to those in the low income bracket that they will be better off," Fishman said in response.

Fishman added that those who will be losing their Medicare prescription drug cards currently covering their prescription drugs will be covered under the new program.

"The prescription drug card was always a temporary program that would be replaced by the Medicare Part D in 2006," she said.

Others pointed to how the drug benefit is going to be financed, a debate that has been going on in Congress since the release of President Bush's budget in February.

Scanlon pointed out that there is "constantly fine tuning going on" in the bill's implementation and financing.

However, he said there needs to be more debate over how to sustain the Medicare program for years to come.

"We need to have a discussion about how we are going to finance long-term care in the future," Scanlon said.

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