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Emergency State Program To Pay For Seniors Medicine

Posted: 8:57 pm PST January 12, 2006Updated: 12:12 am PST January 13, 2006

Alarmed by reports that some senior citizens are having trouble getting prescription medicines under a new Medicare program, California's governor ordered an emergency plan Thursday allowing the state to pay for and provide the drugs for the next two weeks.

With as many as 200,000 people eligible for help, California became the largest of at least nine states that have taken emergency measures to get medicine to low-income senior citizens.

The state will temporarily supply seniors and the disabled with "lifesaving medications they are in danger of losing because of significant problems with the new federal Medicare prescription drug program," Gov. Arnold Schwarzenegger said in a statement.

"Starting later today, the state will be the payer of last resort," he said.

The cost of the emergency program was not announced, but it could run hundreds of thousands of dollars.

The governor directed the Department of Health Services to immediately begin a five-day program to pay for prescription medications for those who have been unable to obtain them through the federal Medicare program.

In addition, the governor said the state Legislature has agreed to introduce legislation to fund the five-day program and extend coverage for an additional 10 days.

The program applies to Californians with so-called dual eligibility for the federal Medicare and the state Medi-Cal health insurance programs. Prescription drug coverage for nearly 1 million dually eligible Californians switched on Jan. 1 from the state-run to the federally subsidized drug program.

In a conference call, California state health officials said some seniors have reported problems getting their drugs because of problems verifying that the Medicare client was enrolled in the new prescription program. While pharmacies have been able to sort out most of the problems, it has taken time and effort.

Pharmacies and clients "attempting to clarify eligibility and Medicare drug plan enrollment have experienced long waits while trying to obtain information from Medicare's overloaded phone lines," according to a statement from the governor's office.

State Health and Human Services Secretary Kim Belshe said federal officials have estimated that one in five dual-eligibility recipients are "at risk for not being to access drugs," or about 200,000 people in California.

"The good news is that the error rates has gone down from 90 percent to 20 percent. The trend is in the right direction," but the governor still feels it is too high, Belshe said.

Medicare is working "very diligently" to solve the problems, said Jeff Flick, regional administrator for the federal Centers for Medicare & Medicaid Services.

"This is a program that is quite large and is working very well for most people. There are some glitches and some problems," he said in the conference call.

Schwarzenegger said he would ask the federal government for reimbursement. Flick said he would work with the state "to help them recover whatever funds are expected."

Health officials said some pharmacies have provided free medications to seniors rather than refuse them. To be reimbursed under the emergency program, a pharmacy will have to certify either that it was unable to obtain information from Medicare that the business needed to submit a claim; that its claim was incorrectly denied; or that the deductible or co-payment of the person receiving the drugs was higher than the one-dollar to five-dollar payment established by Medicare.

New Hampshire, South Dakota, Vermont, Connecticut, Massachusetts and North Dakota all previously announced plans that would enable low-income people to get their medicine if pharmacists were having trouble confirming coverage through the new Medicare benefit. Arkansas and Illinois announced their own plans Wednesday.

New York officials have said the state already had in place a program that would allow its Medicaid program to cover prescription expenses for about 570,000 low-income residents if they experience problems with the new program.

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