Nearly 1 million poor and frail California seniors who will be transferred automatically into the Medicare prescription program Jan. 1 can get transitional help from the state if private insurers under the new plan do not cover their particular medications.
But no one has notified those eligible of the state’s policy -- which provides up to a 100-day supply of medicines they are currently taking, including expensive name brands -- and they only have until Dec. 31 to request and receive the medication.
“How can this be a safety net if the beneficiaries haven’t been notified?” said Betty Dahlquist, executive director of the California Assn. of Social Rehabilitation Agencies, a Bay Area group involved in mental health issues.
“If I was completely cynical, I’d think this was about budget-balancing,” she said.
The notification delay is another snarl in what is shaping up to be a difficult launch for the Medicare prescription drug program. The most significant expansion of Medicare in 40 years is marked by complexity, frustrating beneficiaries and their families as well as government officials and social-service providers who are trying to help.
California officials say they are planning a mass mailing between Wednesday and Dec. 21 to let beneficiaries know that help is available, though the officials acknowledge it is late in the game.
California’s deputy director of medical care services, Stan Rosenstein, dismissed Dahlquist’s suggestion that the state might be trying to keep quiet about the 100-day drug benefit as a way of saving money.
“It is a cost that we decided to pay and we will pay it,” Rosenstein said. “Gov. [Arnold] Schwarzenegger has put in over $100 million to pay for services to make this transition easier. He is invested in this.”
The affected seniors, as well as a considerable number of younger disabled people, are covered by both Medicare and Medi-Cal, a federal-state program that serves the poor and disabled. The federal government has decided to automatically switch these so-called dual eligibles, whose prescriptions are now paid for by Medi-Cal, to the Medicare drug system.
That worries some advocates, because Medi-Cal’s prescription coverage is much more generous than that of many private plans in the new Medicare benefit. Advocates fear that people who depend on expensive drugs will lose access to some medications and wind up in emergency rooms.
“This transition supply of medications is really important to me because if at the end of January I realize that I’m in a plan that is not working for me, I would still have a supply of medications while I figure out what the next plan will be,” said Sheryle Stafford of Concord, Calif., who was disabled by a 1997 car crash and has both Medi-Cal and Medicare.
Stafford, who takes eight medications regularly, said she learned of the 100-day supply because she is a social-service volunteer. But she is concerned about fellow dual eligibles, who are acknowledged to be among society’s most vulnerable people. Many have significant mental or physical impairments and a limited ability to grasp complicated questions.
“We should have been notified months ago,” Stafford said. “How do I have a guarantee that I can get hold of my doctor over the Christmas holidays?”
The state has tried to get out the word, Rosenstein said, but the effort has not been very successful. The 100-day benefit was mentioned in a news release last month but got very little media coverage. State officials also have been trying to let doctors and pharmacists know about it.
“There is still time,” Rosenstein said; beneficiaries just need to “work with the doctors and with their pharmacy.”
“We are basically telling people that if they are concerned about not having access to their drugs, they can get a 100-day supply now,” Rosenstein said.
Medi-Cal will pay for a 100-day supply of most medications, as long as a beneficiary’s doctor issues a prescription and a pharmacist fills it by Dec. 31. Policies for beneficiaries in health maintenance organizations may be more restrictive.
Rosenstein said beneficiaries had not been directly notified yet because the Medicare transition was complicated and because communicating with Medi-Cal beneficiaries was challenging. The information must be conveyed in more than a dozen languages at an elementary-school reading level.
The state decided to send beneficiaries a series of mailings about the transition over the year, each focusing on one topic, Rosenstein explained. The 100-day safety net was left for later in the series.
“This thing is extremely complex, and we were trying to provide information in a way that would be meaningful to our beneficiaries,” he said.
“We were trying to avoid information overload, which I don’t think serves people well either.”