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Long Branch, NJ --- U.S. Rep. Frank Pallone, Jr. (D-NJ), a senior member of the House Energy and Commerce Committee, today urged the Bush administration to provide an uninterrupted transition to new drug plans for an estimated 632,000 seniors who will lose their prescription drug coverage at the end of the year.
The low-income seniors, who were automatically registered for a Medicare Part D Prescription Drug Plan because they were enrolled in Medicaid, will now lose their drug coverage because they are no longer eligible for Medicaid in their respected states. These seniors will now have to enroll for a Part D Plan during the next open enrollment period, which begins on November 15th and ends on December 31st. CMS has already said that it will extend the enrollment period to those seniors who lost their duel eligibility an extra three months without a penalty.
In a letter to Leslie Norwalk, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), the New Jersey congressman wrote that he would like to know what steps the agency is taking to ensure these beneficiaries experience a smooth and uninterrupted transition. He also asked Acting Administrator Norwalk to explain what outreach efforts are being undertaken to help enroll many of the seniors in this group into a low-income subsidy (LIS) program where their monthly premiums would be lower than other Medicare Part D drug plans. Pallone's letter follows.
October 23, 2006
Ms. Leslie Norwalk
Acting Administrator
Centers for Medicare and Medicaid Services
200 Independence Ave., SW
Washington, DC 20201
Dear Ms. Norwalk,
Let me begin by offering my congratulations on your recent promotion to Acting Administrator of the Centers for Medicare and Medicaid Services (CMS). I am looking forward to working with you and your staff to improve the Medicare prescription drug benefit and provide America's seniors and disabled with access to affordable and quality medications.
I am writing today to express my deep concern regarding the enrollment process for beneficiaries who were previously automatically enrolled as a condition of being dually eligible for Medicare and Medicaid benefits. It is my understanding that there are an estimated 632,000 beneficiaries who will no longer be eligible to receive Medicaid benefits under their respective state programs. As a result, these persons will not be automatically enrolled in a Medicare Part D Prescription Drug Plan (PDP).
This is particularly troubling considering the vulnerability of this unique population. While these beneficiaries may no longer qualify as dual-eligibles, I am certain that many still suffer from the same health and income related problems that they did previously. They are still significantly poorer and tend to have far more extensive health care needs. They are still more likely to suffer from chronic conditions such as heart disease, pulmonary disease, and diabetes. Therefore, preserving access to prescription drugs for these individuals is still of vital importance.
Accordingly, I would like to know what steps your agency is taking to ensure these beneficiaries experience a smooth and uninterrupted transition. I am already aware that you are working to notify beneficiaries that they will no longer be automatically enrolled in the Medicare Part D program. I am concerned however that these efforts will be met with limited success. Traditionally speaking, this is a very hard to reach population and it is well within reason to expect many people within this group will fail to realize that they must now take it upon themselves to enroll in a PDP.
As Medicare Part D was first implemented, CMS required each Medicare prescription drug plan to establish an appropriate transition process for all new enrollees, including dual eligibles. These transition plans were to include at least a one-time fill of a prescription drug excluded from the plan's formulary in order to accommodate situations in which a beneficiary's enrollment could not be verified. Furthermore, CMS implemented a process to enroll those dual-eligibles not already auto-enrolled and allow them to still walk away from the pharmacy with their prescriptions. I believe it is imperative that CMS mandate a similar transition policy for all beneficiaries who previously qualified as a dual-eligible.
Finally, I would like to know what outreach efforts are being undertaken to help enroll this group into the low-income subsidy (LIS) program. I would imagine that a fair share of these beneficiaries would qualify for the extra assistance. Given the rather limited success your agency has experienced in enrolling beneficiaries in the low-income subsidy program, I believe a concerted effort to target and enroll these individuals could be highly successful. Such efforts should go well beyond simply sending a notification letter.
I greatly appreciate your attention to this matter and look forward to your quick and thorough response.
Sincerely,
Frank Pallone, Jr.
Member of Congress |
