Lawsuit Seeks Drug Benefit Safety Net
Computer glitches involving the new Medicare drug benefit could leave thousands of frail, impoverished seniors without prescription coverage on Jan. 1, a coalition of consumer groups alleged in a lawsuit against the government filed Monday.
“Because many of these persons need prescription medications to function or survive, the consequences of no longer receiving prescription drug coverage will be calamitous,” said the 19-page complaint filed in U.S. District Court in Manhattan.
The transfer of these beneficiaries to new coverage is one of the most delicate transitions under the complex prescription drug benefit, the centerpiece of President Bush’s Medicare overhaul.
The Medicare Rights Center and seven other organizations want to force the government to develop stronger safeguards for 6.4 million elderly and disabled beneficiaries who now get prescriptions through Medicaid and medical services through Medicare. Called “dual eligibles” by the government, they are poor and many are suffering from severe physical and mental disabilities.
An estimated 1 million of these beneficiaries live in California, more than in any other state.
Medicare spokesman Gary Karr declined to comment on the lawsuit, but said the agency was working on an additional layer of protection to prevent breaks in coverage.
“We are working on a new safety net process as a backstop,” Karr said. “Somebody who has Medicare and Medicaid can go to the pharmacy and show proof and get his or her prescription filled.”
The law that created the Medicare drug benefit called for these poor and frail beneficiaries to enroll in a drug plan before Jan. 1, when their Medicaid prescription coverage is set to expire. The government says those who don’t pick a Medicare drug plan on their own will be automatically enrolled in one to prevent interruptions in coverage.
But that, the consumer groups contend, is easier said than done.
Coordination issues and computer problems involving federal and state databases of beneficiaries guaranteed that there would be bureaucratic problems, the lawsuit alleged.
“It is virtually certain that on Jan. 1, 2006, some ... dual eligibles will not be receiving prescription drug coverage under” Medicare, the lawsuit said. “There is no way to know with certainty how many ... will fall through the cracks this way. However, even if the enrollment process captures 97% of all dual eligibles, more than 180,000 will not be enrolled.”
As a precaution, the groups want a federal court to order the government to maintain temporary Medicaid prescription coverage for any beneficiary who runs into problems with the new Medicare benefit.
“We want to ensure that a safety net is in place for the neediest Americans, who are at risk of losing their access to medicines,” said Robert M. Hayes, president of the Medicare Rights Center, a nonprofit independent information resource. “Errors by the system are inevitable. What makes this transition so perilous is the nature of the people affected: They are very old, they are very sick and they are extremely poor.”
But federal and state policymakers are reluctant to incur the extra costs that a safety net would entail. In California, senior and disabled beneficiaries making the transition are being advised to get a 100-day supply of prescriptions from Medi-Cal before the end of the year, in case of any problems.
Although the transition for the poorest and frailest beneficiaries is supposed to be complete by Jan. 1, open enrollment for most other seniors begins today and runs through May 15.
