A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

More Medicare Part D Mishegas

More Medicare Part D Mishegas

May 2, 2006

HCFA’s Melissa Shannon testified at a MassHealth hearing today on implementation of a law to protect Massachusetts residents who were required to switch from Medicaid drug coverage to the new Medicare prescription drug program. (These people are called “dual eligibles”). HCFA worked Sen. Mark Montigny and others in filing and passage of this law, known as Chapter 175. In truth, MassHealth has done a heroic job trying to implement the absurdly complicated and expensive federal program. We’ve got two big differences on how it should be implemented.

1) Transition Coverage: The new law (http://www.mass.gov/legis/laws/seslaw05/sl050175.htm) sought to provide a one-time 30-day drug supply to anyone required to switch to the federal program, and who couldn't get meds through the new Medicare program. MassHealth is only paying for these 30-day supplies if the recipient has a part D plan and that plan denies payment. This leaves out hundreds of duals who fail to show up on the pharmacist’s computer as enrolled in a part D plan. The feds were supposed to enroll these people, but neither the federal program, nor its back up plan work.

2) Co-pays: Chapter 175 states no dual should pay a higher co-pay under the federal program than they would pay under Medicaid. But MassHealth found a way to leaves hundreds of people without protection. For duals who are charged co-pays of $2 and $5, MassHealth is lowering those payments to $1 and $3, but for anyone who does not show up in the computer as receiving the low-income subsidy, MassHealth offers no relief. The feds were supposed to enroll all duals in the low income subsidy. But it's not happening as it should.

Massachusetts is a national leader in providing health care to vulnerable residents. We violate our standard by failing to provide prescriptions to our most vulnerable residents and saying the federal government bears responsibility for these coverage gaps. The Commonwealth should address the gaps in coverage created by the Medicare Part D legislation.

Sen. Montigny and a great team of advocates joined Melissa to make these arguments at the hearing. Hopefully this is one we can do something about.