Congresswoman Lucille Roybal-Allard (CA-34) Introduces Legislation to Help People with Mental Disabilities Successfully Navigate and Access the Medicare Prescription Drug Plan
Washington,
May 13, 2009 -
Click here to read the full text of the congresswoman’s floor statement about the GUIDE Act
Congresswoman Lucille Roybal-Allard (CA-34) joined by Congressman Pete Sessions (R-TX) introduced legislation today in the U.S. House of Representatives to provide counseling services to assist cognitively impaired individuals facing obstacles to obtaining medications they are eligible for under Medicare.
The legislation, called The Guidance, Understanding and Information for Dual Eligibles (GUIDE) Act (HR 2390), specifically targets 7 million individuals in our country who are enrolled in both the federal Medicare health insurance program because of age or disability status and the Medicaid program, which is administered by states to provide health care to low-income individuals and families. Beneficiaries eligible for both programs are called “dual eligibles.”
Almost 40 percent of these ‘dual eligible’ beneficiaries are cognitively impaired. Their diagnoses include mental retardation, mental illness, autism and dementia. In addition, more than 75 percent of people who qualify for both programs are determined to have one or more “functional limitations,” which includes difficulties with independently managing money, eating, bathing or getting dressed.
The GUIDE Act would assist this group of beneficiaries in finding the right Medicare prescription drug plan for them by creating a demonstration program to provide one-on-one counseling services. The measure would also require that counseling services be provided by trained social workers and counselors in community mental health centers and other community-based non-profit organizations.
“Low-income Americans who already contend with a disability that affects their cognitive capacity, such as individuals with Down Syndrome or Schizophrenia, require adequate counseling to ensure easy access to appropriate medications. Under the wrong insurance plan, filling needed prescriptions can be so complicated that many people end up skipping their medication. They need guidance finding a Part D plan that provides sufficient coverage,” Congresswoman Lucille Roybal-Allard said. “Right now, for individuals with mental disabilities, the Medicare prescription drug program does not provide adequate assistance to help them enroll and change drug plans when needed.”
These dual eligible beneficiaries began having difficulties obtaining their medications when the Medicare Modernization Act established the Medicare Part D Program, which took effect January 1, 2006. The process requires dual-eligible beneficiaries to navigate a complicated web of prescription plans in order to obtain coverage for their medications. If the dual eligibles do not engage in the selection process, they are auto-enrolled in plans that may not be the best plan for them. Frequently reported problems experienced by dual beneficiaries include prohibitive co-pays, restricted formularies that do not cover their specific medication, and medication exclusions that block out entire categories of medications under a particular plan.
Studies have confirmed Congresswoman Roybal-Allard’s reasons for concern. Because of the daily life challenges that many dual eligible citizens face, they have experienced documented medication access problems while attempting to negotiate the overwhelmingly complex array of prescription drug plans established by the Part D program. In addition, medication access problems have been linked to serious adverse events, including increased emergency room visits and hospitalizations. An American Journal of Psychiatry study showed that close to one third of dual eligible psychiatric patients who experienced a medication access problem also had a serious adverse event.
“By helping people with mental disabilities obtain their medications and lead healthy lives, the GUIDE Act has the potential to drive down social and economic costs associated with these medication-related adverse events,” Congresswoman Lucille Roybal-Allard said.
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