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Jewish World Review May 10, 2005 / 1 Iyar, 5765 Poor drug prescription coverage for nursing home residents By Jan L. Warner & Jan Collins
http://www.JewishWorldReview.com |
Q: Our mother has been in a nursing home for five years. She lived alone
after Dad died in 1989, and when she became unable to care for herself,
we spent her assets hiring people to help keep her at home and pay for
her medicine. Three years ago, when she could not continue to live at
home, we sold our family property and spent the rest of her money paying
for her care at the nursing home. During this time, we paid for her
prescriptions, which rose in price.
When she finally qualified for Medicaid two years ago, we were relieved
because Medicaid at least picked up the cost of her prescriptions. (We
made a mistake by not paying for her burial in advance because she has
no money left, and all but $30 of her monthly Social Security check goes
to the nursing home.)
We have heard a lot about the new Medicare drug plan, but we don't
understand what effect it will have on Mom. Will this new drug program
supplement what Medicaid is now paying?
A: Because of poor governmental planning, thousands of nursing home
residents like your mother may well be at risk and lose coverage for
life-sustaining medications come Jan. 1, 2006, when Medicare Part D
becomes law.
Due to space limitations, we can give you only a brief overview of the
situation facing our institutionalized seniors next January, but if you
visit our Web site (www.nextsteps.net), you'll find more in-depth
material about this looming crisis.
Like your mother, the majority of nursing home residents receive
Medicaid that, in turn, provides their prescription drugs. But because
your mother is also a Medicare recipient and is therefore "dually
eligible" for Medicare and Medicaid, beginning Jan. 1, 2006, she could
well be scheduled to lose her prescription coverage now provided by
Medicaid — unlike regular Medicare recipients who have six months to
decide whether to move into Part D or opt out.
Here are some of the problems that require immediate solutions:
1) Part D calls for Medicare beneficiaries to compare the available
prescription drug plans (PDPs) and choose the one best suited to their
needs. (However, a large number of nursing home residents have capacity
impairments and won't be able to understand the differences.)
2) Nursing home residents who are dually eligible for Medicare and
Medicaid will be randomly assigned a PDP by the Centers for Medicare and
Medicaid Services. Given that each PDP offers different medications and
uses different pharmacies, this arbitrary assignment may not offer the
prescriptions taken by the resident and may conflict with the pharmacy
used by the nursing home. While each nursing home resident has the right
to change to another PDP, many of the patients may not understand what
they're choosing, as we previously mentioned. Those who may not be
identified will lose coverage altogether. Those who are identified may
have some prescriptions not available to them.
3) Part D does not cover certain prescriptions, including those used in
the majority of nursing facilities for muscle spasms, seizures, anxiety,
etc. Since only those states with Medicaid programs that cover
prescriptions excluded by Medicare will continue coverage for these
medications, it is a good idea to see if your mom's coverage will
continue in your state; however, with state budget cuts, it may well be
that some states will terminate coverage.
4) Since there will be added administrative duties placed on nursing
home personnel and physicians, resident care could be impacted, and, as
usual, any additional costs will be shifted onto private pay residents,
reducing more quickly the funds available for their care and eroding the
long-term care insurance daily rates that insured Americans have purchased.
Sadly, final regulations regarding nursing home drug coverage have
already been distributed to the PDPs. Should Congress and the president
choose not to address how these regulations overlook some of our most
vulnerable relatives before Jan. 1, it's possible that many nursing home
residents like your mother, who receive both Medicaid and Medicare,
could become even more chronically ill or die prematurely. We suggest
that you contact your congressman and senators and let them know that
the prescription drug program is not working for your loved one. And,
with White House Conference on Aging soliciting ideas about how to make
the aging process better (http://www.whcoa.gov/) here is one suggestion
to send on.
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JAN L. WARNER received his A.B. and J.D. degrees from the University of South Carolina and earned a Master of Legal Letters (L.L.M.) in Taxation from the Emory University School of Law in Atlanta, Georgia. He is a frequent lecturer at legal education and public information programs throughout the United States. His articles have been published in national and state legal publications. Jan Collins began co-authoring Flying SoloŽ in 1989. She has more than 27 years of experience as a journalist, writer, and editor. To comment or ask a question, please click here. © 2005, Jan Warner |
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