WASHINGTON – Due to serious and widespread problems in implementing the new Medicare Part D benefit, U.S. Benjamin L. Cardin will introduce legislation when the House returns Jan. 31 allowing states to fully deduct any money they owe the Medicare program for expenditures they have laid out to help their low-income Medicare beneficiaries purchase their medications.  At least 20 states have recognized that the situation is a public health emergency and have stepped in to help their low-income beneficiaries with their prescription drug costs.

Since the Medicare Part D benefit went into effect on Jan. 1, 2006, many low-income seniors who were promised “special assistance” have run into a bureaucratic nightmare when they try to purchase their medications.  By law, Medicare beneficiaries who qualify for special assistance are exempt from a deductible and their copayments are not to exceed $5.

Many plans have no record of some beneficiaries’ enrollment, and many beneficiaries have not received a drug card proving their enrollment.  At the same time, pharmacists have been unable to get through to insurance companies’ telephone lines or the Center for Medicare/Medicaid Services (CMS) to verify eligibility.  As a result, many beneficiaries have been turned away from pharmacies before they can receive their medicines.

The Bush Administration has announced that the federal government will not repay states for their expenditures, and that states will have to recoup the money they have expended from private insurance plans that provide the Part D coverage.

“Since Jan. 1, many states have spent millions of dollars to ensure their low-income citizens receive the benefit they were promised by the federal government.  The federal government had more than two years to implement this benefit and clearly should have anticipated many of these problems.  The federal government failed in its responsibility to provide all seniors who signed up with the Part D benefit with their medicines. It now has the responsibility to step in and make sure that states are not left holding the bag for doing the right thing,” said Rep. Cardin.
 
Rep. Cardin’s Medicare Emergency Drug Intervention Compensation Act would give states credit for the expenditures they have made on behalf of their low-income beneficiaries under what is known as the “clawback” process.  Under the 2003 Medicare Modernization Act, states are required to reimburse the federal government each month for the amount they save because, under the Part D benefit, they no longer have to provide prescription drug coverage through Medicaid to low-income beneficiaries. The Congressman’s bill would permit states to deduct the cost of drugs they have provided low-income seniors from the total they remit to the Medicare program.

On Jan. 17, 14 governors wrote President Bush demanding reimbursement for costs they have incurred in providing emergency drug coverage for low-income seniors. California has announced it expects to spend as much as $150 million to ensure its low-income Medicare beneficiaries get the medicines they need and were promised under the Part D benefit.

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