Medicaid transition rough, but better coverage coming, officials say

Published 5:00 am Tuesday, June 22, 2004

The Medicaid Reform Act of 2004 will provide much bettercoverage for the aged and needy, legislators and program expertsagree, but the transition has proved to be thorny, at best, andpotentially lethal, at worst.

Confusion over prescription discount cards, coupled with a lackof information on how those cut from the Medicaid program can findassistance, have resulted in a chaotic environment that has manyconcerned they may not be able to receive necessarymedications.

“This whole thing is to bridge an 18-month span until the newMedicare program kicks in,” said Francis Rullan, director of publicrelations for Medicaid.

“We are the same Medicaid personnel who have overseen thisprogram for years,” he said. “We’re not trying to hurt anyone. Iwouldn’t be here if I didn’t believe it works and could helppeople. We are trying to sustain this program for the good ofeveryone in it.”

The problem, Rullan said, results from massive growth in theprogram at a level the state is unable to match. The Poverty LevelAged and Disabled (PLAD) program was expanded in the 1990s — whenthe program had a $150 million surplus — to include those slightlyover the poverty level. The expansion enabled the enrollment ofthose up to 135 percent of the poverty level. Mississippi was theonly state offering Medicaid to those over the poverty level.

“Now the legislature has seen that they were not able to supportthat program anymore. The surplus has been exhausted, and there isnot stable funding being diverted into the PLAD program,” Rullansaid.

Letters were mailed to everyone in the PLAD program notifyingthem it was going to be terminated, he said. The termination wouldaffect about 65,000 Mississippians.

Most of those were dual eligible, meaning they qualified forboth Medicare and Medicaid assistance. Their Medicare coverage isstill intact and will be greatly enhanced when the Medicaid ReformAct of 2004 takes effect on Jan. 1, 2006, Rullan said.

However, their Medicaid benefits, which cover a majority of theprescription drug assistance, have taken a hit until Medicarereform becomes effective.

Under Medicaid, patients had been receiving up to sevenprescriptions a month, with only a few dollars in out-of-pocketexpense. That’s being changed to four name-brand drugs andunlimited generics for people who can join the Medicareprogram.

Approximately 60,000 of these Medicaid customers can apply for aMedicare Drug Discount Card, which provides a $600 credit for 2004and an additional $600 credit for 2005. It also includes savings onbrand name drugs from 16-30 percent off retail prices and 30-60percent on generic drugs, Rullan said.

In addition, those customers are eligible through Medicaid for aManufacturer’s Drug Discount Card that can be used in conjunctionwith the Medicare card to increase savings, he said.

Approximately 5,000 customers in the PLAD program are noteligible for the drug cards, however, because they do not qualifyfor Medicare. Gov. Haley Barbour is seeking waivers from thefederal government to allow Medicaid to keep covering those whodon’t immediately qualify for Medicare.

Many of those cut from the PLAD program say the drug cards arenot enough. Some even have one prescription a month that costs morethan the $600 annual credit found on the discount card.

“Even with those tools they cannot meet the needs for theirmonthly medications, not including treatments,” said District 53Rep. Bobby Moak. “The bottom line is it’s just not enough to helpthese people.”

District 92 Rep. Dr. Jim Barnett agreed. “We’ve got to get thesepeople covered,” he said.

Barbour, facing sharp criticism from the public, has claimedsome don’t know where to look for the discounts, or even freedrugs. He said citizens being moved off Medicaid should qualify forprograms that could help them get any of 1,350 prescriptions freeor for no more than $15 a month.

The governor is considering allowing a three-month extension tothe Medicaid program to allow those on the program to get furtherassistance on how to apply for these programs and delayimplementation until his promised waivers come through.

District 39 Senator Cindy Hyde-Smith said she recommended a sixmonth stay, but any delay is welcome. The waivers would be evenmore welcome, she said.

“I think they will come through, but I’m going to have to havesome assurances that if they don’t, he’ll call a special session toreaddress this issue,” she said. “We have got to take care of thesepeople who simply can’t be cut off. It was never the intent of thelegislature for people to go without coverage. We were assured thewaivers would be there before the session ended.”

Local legislators, however, say it won’t be enough and areencouraging the governor to call a special session to give them theopportunity to correct passing the legislation. The Medicaid billwas passed by an overwhelming majority in both houses ofgovernment.

There are three possibilities for more assistance, Moak said,and all rely on the governor. The governor could call a specialsession and allow them to fix it; he could get his waivers; or “anoutside shot would be appealing the adjournment, which would put usright back in session where we could address the issue.”