Medicare Part D major disaster for chronically ill

[okarol]

Medicare Part D major disaster for chronically ill

Once able to get help with medical bills, residents now caught in gray area as their health declines

By Liz Freeman naplesnews.com

Tuesday, November 28, 2006

They are at wit's end when medical bills arrive in the mail that Medicaid used to pay.

There is no way many of the 38,000 chronically ill Florida residents who once were part of the state's Medically Needy program can pay the bills for their visits to specialists, for laboratory tests or dialysis, given that they struggle to live on disability income of about $800 a month.

With the launch of the Medicare Part D drug program this past Jan. 1 by the federal government, many of the Medically Needy no longer qualified for the state program. That meant the state's Medicaid program quit picking up the tab for their medical expenses.

"We figured a lot of people were going to take a hit but we didn't realize how many," said Karen Paladino, a social worker at dialysis centers in Bonita Springs and Naples owned by Fresenius Medical Care.

When Medicare Part D moves into its second year this coming January, more chronically ill patients now covered by the Medically Needy program will be in the same bind when they are required to have Part D drug plans.

A petition is circulating around the state for patients, their families and any concerned citizens to sign that asks the Florida Legislature to address the life-and-death quagmire that many of the Medically Needy are facing when they lose Medicaid assistance.

"We can't get sick people to Tallahassee but now they can get there on paper (the petition)," said Mary Ellen Ross, executive director of the Florida Transplant Survivors Coalition in Delray Beach. "What we would like to do is open a dialogue with the Florida Legislature and look at Part D and income levels."

At issue is the structure of the Medically Needy program, started in 1986 to provide temporary Medicaid coverage for residents who face a catastrophic medical condition but whose incomes are too high, often by a meager amount, to qualify for traditional Medicaid.

They must qualify every month for Medically Needy coverage by meeting their "share of cost," when their total medical expenses for the month would add up to 75 percent of their monthly income. At that point, Medicaid kicks in for the rest of the month.

Traditionally, the patients would reach their share of cost when they totaled up their monthly drug expenses. They or their social workers would submit their total drug bill for the month to the state. Medicaid then would cover the drug bills and all other medical expenses for the month.

That all changed when Medicare Part D came into being this past Jan. 1. Many of the Medically Needy are "dual eligibles" with Medicare. They were automatically enrolled in Part D plans and that meant they could no longer count their drug expenses toward their share of cost each month.

So they no longer qualified for the Medically Needy program and immediately were left with bills for doctor visits, lab tests or dialysis. Some have reacted by not going to doctors' appointments or for laboratory tests and their health is declining. Others are tapping the compassion of their physicians for free care or for payment plans, Ross said.

"Our illnesses are not getting better," Ross said. "We are not here for a free ride but honestly when you are given a certain amount of money to live on and can't get care, we will be forced into hospitals. Share of cost is a very large issue."

Paladino, with the local dialysis centers, said her Medically Needy patients were facing enough stress in their daily lives because of their illnesses, so the impact of Part D has been tremendous.

"People who were (medically) stable are not stable anymore," she said.

Physicians are helping out by billing them but not actively pursuing payment, she said. Her dialysis centers are not turning the patients away even though the centers know Medicaid isn't picking up the bills anymore, Paladino said.

Lifelink Foundation in Tampa, an organ procurement and transplant program, saw numerous transplant recipients lose their Medically Needy coverage.

"It was unbelievable. The outcry was enormous and justifiably," said Rebecca Arsenault, Lifelink spokeswoman.

Statistics for how many Southwest Florida residents lost their Medically Needy coverage this past January weren't readily available from the state Department of Children and Families. Last November, 776 individuals from Lee County and 338 people from Collier County were in the program.

The petition asks state lawmakers to revise the Medically Needy share of cost by using a sliding scale formula according to federal poverty guidelines. That would help

The petitioners will collect signatures through the end of December. Supporters can sign it at dialysis centers, transplant hospitals or online at www.floridachain.org.

"The more we get the word out, the better we are going to be," said Bette Luksha, another member of the survivor transplant coalition.

At the same time, Luksha realizes that homeowners' insurance reform and immigration are priority issues next spring for the state Legislature.

"I believe we will be coming in with open minds and other options to the sliding scale (proposal)," Ross said. "I would like to see some hearings, to tell people exactly who we are and how by the third week of the month don't have any money to live on."

Lifelink representatives are backing the petition and have met with elected officials from the Tampa region to inform them of what is happening, said Arsenault, of Lifelink.

"It's heartbreaking," she said. "It flies in the face of everything we try to accomplish here."

•••

A grassroots petition in Florida asking the Legislature to restructure the state's Medically Needy program can be seen and signed at www.floridachain.org.

original story: http://www.naplesnews.com/news/2006/nov/28/petition_asks_legislature_look_medically_needy/

[jbeany]

Been there, done that.  Before my disability kicked in, I tried a couple of different programs to help with the bills.  At the time, Hubby made between $500 to $1000 to much a year to qualify for any real help.  Like that $1000 a year was enough to really make a huge difference. 

At one time, just after he got a raise, Medicare told me I didn't qualify for full scrip coverage anymore.  I had to switch to a "spend-down" account.  After you pay out $800 in scrips, they pick up the rest - just send in your receipt.  Well, okay, that will only take one scrip, since I was on Procrit every week.  Retail cost at the time for a month's supply was almost $2000.  Funny, though, the woman on the phone at the Medicare office didn't have any bright ideas about where I was supposed to get $2000 to go pick up the stuff in the first place.   

[stauffenberg]

When England was just emerging from the disastrous expenses of World War II, it introduced a national healthcare plan which not only covered all doctors' bills, hospital expenses, and diagnostic tests, but also provided full coverage for all dental care and for all prescription medications.  But why the world's richest nation, the United States, today has to impose such financial burdens on its chronically ill population is inexplicable.

[Black]

Medicare Part D major disaster for chronically ill

Once able to get help with medical bills, residents now caught in gray area as their health declines

By Liz Freeman naplesnews.com

Tuesday, November 28, 2006

They are at wit's end when medical bills arrive in the mail that Medicaid used to pay.

There is no way many of the 38,000 chronically ill Florida residents who once were part of the state's Medically Needy program can pay the bills for their visits to specialists, for laboratory tests or dialysis, given that they struggle to live on disability income of about $800 a month. ...

My parents live in FL and I am somewhat familiar with the medical/Medicare/Medicaid programs available there.  I am skeptical of the article's claim that there is any US citizen in FL living in poverty, with an income of $800 per month, who does not qualify for any assistance with medical and medical related expenses.

The following is from government web sites.

"...Apply for Extra Help

If you have Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. If you qualify, you could pay between $1-$5 for each drug.
Contact Social Security by visiting www.socialsecurity.gov or by calling 1-800-772-1213. TTY users should call 1-800-325-0778 ..."  http://www.medicare.gov/bridging-the-gap.asp

"... 2006 Yearly Income and Resource Limits to Qualify for Extra Help

single          income less than $14,700 and resources less than $11,500
married        income less than $19,800 and resources less than $23,000..."
http://www.medicare.gov/publications/pubs/pdf/10050.pdf

Resources include savings and stocks, but do not include house and car.  Anyone who qualifies for "Extra Help" gets assistance paying premiums, deductibles, and copayments.

Also this:

"...Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses...." 
http://www.cms.hhs.gov/MedicaidEligibility/

While I understand that some of these government sites may not yet be updated, I believe that if there had been a significant change in law affecting people in FL, my parents would have been notified and I would have heard about it.  If anyone does have information on changes for 2007 I'd be interested, as it will affect my parents.

[BigSky]

IMO the article is a hack job.

They are trying to make the part D program a scapegoat.

From their linking of those on Medicaid for being medically needy to that of those who received Medicare and the part D program who are "dual" eligible.

The part D program has no affect on those who are only eligible for Medicaid, it affects only those who have dual coverage.

As such those who are chronically ill and are on Medicare are most likely were only on Medicaid for the drug coverage as Medicare covers lab testing etc.  Also the income of $800 makes them eligible for extra help as stated by Black.   That program is called QMB and it pays the 20% that Medicare does not pay and QMB also pays for Medicare premiums and the "donut hole" of the Part D program.

There are some problems with the programs in coverage for people over the $800 amount.  However those problems existed before part D was established.

[Zach]

When England was just emerging from the disastrous expenses of World War II, it introduced a national healthcare plan which not only covered all doctors' bills, hospital expenses, and diagnostic tests, but also provided full coverage for all dental care and for all prescription medications.

Yes, and what did the selfish, capitalist United States do at that time?  Something called The Marshall Plan.  Along with the UNRRA, European postwar recovery was assured.

Thank you very much.   

[jbeany]

When England was just emerging from the disastrous expenses of World War II, it introduced a national healthcare plan which not only covered all doctors' bills, hospital expenses, and diagnostic tests, but also provided full coverage for all dental care and for all prescription medications.  But why the world's richest nation, the United States, today has to impose such financial burdens on its chronically ill population is inexplicable.

Because the world's richest nation spends too much of its citizen's tax money on the military that the rest of the world expects will show up to help them whenever they have a problem. 

[JerseyGirl]

Way to go jbeany and Zach... Stauffenberg you appearto be a most negative person - unfortunately - I'll bet you always see your glass as half empty...too bad - from us Americans hope always springs external...

[Zach]

Way to go jbeany and Zach... Stauffenberg you appearto be a most negative person - unfortunately - I'll bet you always see your glass as half empty...too bad - from us Americans hope always springs external...

 

[stauffenberg]

The Marshall Plan was utterly selfish and just a method to keep the devastated nations of non-Communist Europe plus Turkey from becoming communist themselves.  If the U.S. was going to keep markets open for its manufacturing industry to make profits, the taxpayer had to contribute to keeping other nations within the sphere of the market economy.

The richest 20% of the world's population now consumes 83% of the world's resources, while the poorest 80% have to make ends meet with only 17% of the world's resources.  One result of this imbalance is that every year 5 million people in the Third World die of starvation.  Usually the international finance capital system, the World Bank, and the whole range of Globalization treaties keep this imbalance working in favor of the richest countries.  Occasionally, however, when it looks as though some part of the Third World is getting out of line and is making a bid to upset this structure of exploitation, the captialists actually have to resort to physical force to maintain the status quo, whether by funding local rebellions, as in Allende's Chile in 1973, or by waging full-scale war as in Vietnam.  While the U.S. incidentally benefits other rich countries when it sends spies, agents provocateurs, or military force abroad, it is mainly doing so for its own selfish interests.

And by the way, I'm an American citizen, though I live outside the country because I don't like American policies and because the only way I can get full health insurance is through a public healthcare system.

[JerseyGirl]

No doubt on the dole living somewhere else. Look bud we can't teach you anything - you seem to know everything already.  Why do you still hang on to your citizenship if you don't believe in its principles?  Seems alittle hypocritical to me.  But hey, I guess there are all kinds and that is what makes the world go round.

[BigSky]

The Marshall Plan was utterly selfish and just a method to keep the devastated nations of non-Communist Europe plus Turkey from becoming communist themselves.  If the U.S. was going to keep markets open for its manufacturing industry to make profits, the taxpayer had to contribute to keeping other nations within the sphere of the market economy.

Utterly selfish? 

Hmm those of East Germany who risked life and limb to leave communism would disagree with you.   

We see just how well the people as a whole of the Soviet Union, China, North Korea live in comparison to the people of the US, Australia and Great Britain.

[Zach]

And by the way, I'm an American citizen, though I live outside the country because I don't like American policies and because the only way I can get full health insurance is through a public healthcare system.

Nature or nurture?  Where you born a U. S. citizen or a naturalized U.S. citizen?  You were in your forties when you became ill, didn't you have your own health insurance?  Didn't you work?

I'm in the U.S., and when I started hemodialysis I was just a few years out of college in 1982.  My HMO covered the treatment until Medicare kicked-in, which at that time took perhaps three to six months.  For over twenty-four years, U. S. Medicare Insurance has paid most of my healthcare costs, with my private supplemental insurance paying the difference.

For those who don't work, the New York State-run Medicaid Insurance program covers the difference.  Of course it's not a perfect system, but hardly what you make it out to be.

[angela515]

And by the way, I'm an American citizen, though I live outside the country because I don't like American policies and because the only way I can get full health insurance is through a public healthcare system.

Nature or nurture?  Where you born a U. S. citizen or a naturalized U.S. citizen?  You were in your forties when you became ill, didn't you have your own health insurance?  Didn't you work?

I'm in the U.S., and when I started hemodialysis I was just a few years out of college in 1982.  My HMO covered the treatment until Medicare kicked-in, which at that time took perhaps three to six months.  For over twenty-four years, U. S. Medicare Insurance has paid most of my healthcare costs, with my private supplemental insurance paying the difference.

For those who don't work, the New York State-run Medicaid Insurance program covers the difference.  Of course it's not a perfect system, but hardly what you make it out to be.

Your very correct on this one Zach. I learned the hard way about insurance, I went on dialysis this time in 2004, I was working at the time so I had a HMO, which covered everything I just paid my usual co-pays... then I lost my job, and eventually my insurance because I stopped paying my insurance bill (stupid me) so I immediatly got Medicare as my primary, and didn't have a Medicare supplement, didnt even know they existed and nobody told me. So I racked up bills while living in Vegas on dialysis... but I now live in Iowa and my social worker got me a Medicare supplement right away, to pay my 20%, so I have no out-of-pocket expenses anymore from dialysis. Yay... I should of been smart earlier and I wouldnt of had to learn the hard way. LOL

[glitter]

And by the way, I'm an American citizen, though I live outside the country because I don't like American policies and because the only way I can get full health insurance is through a public healthcare system.

So how does your host country like you living there for the free health benefits? 

[Zach]

And by the way, I'm an American citizen, though I live outside the country because I don't like American policies and because the only way I can get full health insurance is through a public healthcare system.

Now that you have a transplant, are you working full time or part time?

With a co-payment, Medicare Part D pays for Zemplar, but your beloved Canadian System (no offense to our Canadian members) seems not to, according to one of our members. 

[mrhecht]

I'm in the U.S., and when I started hemodialysis I was just a few years out of college in 1982.  My HMO covered the treatment until Medicare kicked-in, which at that time took perhaps three to six months.  For over twenty-four years, U. S. Medicare Insurance has paid most of my healthcare costs, with my private supplemental insurance paying the difference.

I'm looking at this thread late, but have a question for Zach, so I hope you check this thread! I've been on dialysis since 1989 and lost my secondary insurance in 1996 when I moved from Colorado to Texas. I didn't stop working but the company I worked for didn't offer health insurance and now I'm self-employed. I've never been able to buy a 'supplemental' Medi-gap policy because I've been told that because I started dialysis prior to 1992, I'm not eligible. You mention private supplemental insurance.......through an employer or is it a Medicare supplement?

[Zach]

I'm looking at this thread late, but have a question for Zach, so I hope you check this thread! I've been on dialysis since 1989 and lost my secondary insurance in 1996 when I moved from Colorado to Texas. I didn't stop working but the company I worked for didn't offer health insurance and now I'm self-employed. I've never been able to buy a supplemental Medi-gap policy because I've been told that because I started dialysis prior to 1992, I'm not eligible. You mention private supplemental insurance.......through an employer or is it a Medicare supplement?

I believe once Medicare became my primary insurance in late 1982, my HMO became the secondary payer.  Even before I became ill I never received employer health insurance from ABC when I worked for them--I always paid my own HMO premiums (the original HMO policy was a family plan my Father had from his work).

I dropped the HMO soon after it became secondary and opted for Blue Cross and Blue Shield Medi-gap insurance.  I seem to remember that open enrollment in the Medi-gap insurance occurred once a year.  But remember, private insurance is a State-regulated industry, so policies vary from State to State.

I hope that explains it ... if not in a convoluted way.
 

[bdpoe]

Fistly I am on of those Floridians deemed "medically needy with a share of cost" and have been shafted by
the New Medicare Part D program. The article is right on.

Each state is different. Florida is one of the four worst states in social spending.

Medicare Part D major disaster for chronically ill

Once able to get help with medical bills, residents now caught in gray area as their health declines

By Liz Freeman naplesnews.com

Tuesday, November 28, 2006

They are at wit's end when medical bills arrive in the mail that Medicaid used to pay.

There is no way many of the 38,000 chronically ill Florida residents who once were part of the state's Medically Needy program can pay the bills for their visits to specialists, for laboratory tests or dialysis, given that they struggle to live on disability income of about $800 a month.

With the launch of the Medicare Part D drug program this past Jan. 1 by the federal government, many of the Medically Needy no longer qualified for the state program. That meant the state's Medicaid program quit picking up the tab for their medical expenses.

"We figured a lot of people were going to take a hit but we didn't realize how many," said Karen Paladino, a social worker at dialysis centers in Bonita Springs and Naples owned by Fresenius Medical Care.

When Medicare Part D moves into its second year this coming January, more chronically ill patients now covered by the Medically Needy program will be in the same bind when they are required to have Part D drug plans.

A petition is circulating around the state for patients, their families and any concerned citizens to sign that asks the Florida Legislature to address the life-and-death quagmire that many of the Medically Needy are facing when they lose Medicaid assistance.

"We can't get sick people to Tallahassee but now they can get there on paper (the petition)," said Mary Ellen Ross, executive director of the Florida Transplant Survivors Coalition in Delray Beach. "What we would like to do is open a dialogue with the Florida Legislature and look at Part D and income levels."

At issue is the structure of the Medically Needy program, started in 1986 to provide temporary Medicaid coverage for residents who face a catastrophic medical condition but whose incomes are too high, often by a meager amount, to qualify for traditional Medicaid.

They must qualify every month for Medically Needy coverage by meeting their "share of cost," when their total medical expenses for the month would add up to 75 percent of their monthly income. At that point, Medicaid kicks in for the rest of the month.

Traditionally, the patients would reach their share of cost when they totaled up their monthly drug expenses. They or their social workers would submit their total drug bill for the month to the state. Medicaid then would cover the drug bills and all other medical expenses for the month.

That all changed when Medicare Part D came into being this past Jan. 1. Many of the Medically Needy are "dual eligibles" with Medicare. They were automatically enrolled in Part D plans and that meant they could no longer count their drug expenses toward their share of cost each month.

So they no longer qualified for the Medically Needy program and immediately were left with bills for doctor visits, lab tests or dialysis. Some have reacted by not going to doctors' appointments or for laboratory tests and their health is declining. Others are tapping the compassion of their physicians for free care or for payment plans, Ross said.

"Our illnesses are not getting better," Ross said. "We are not here for a free ride but honestly when you are given a certain amount of money to live on and can't get care, we will be forced into hospitals. Share of cost is a very large issue."

Paladino, with the local dialysis centers, said her Medically Needy patients were facing enough stress in their daily lives because of their illnesses, so the impact of Part D has been tremendous.

"People who were (medically) stable are not stable anymore," she said.

Physicians are helping out by billing them but not actively pursuing payment, she said. Her dialysis centers are not turning the patients away even though the centers know Medicaid isn't picking up the bills anymore, Paladino said.

Lifelink Foundation in Tampa, an organ procurement and transplant program, saw numerous transplant recipients lose their Medically Needy coverage.

"It was unbelievable. The outcry was enormous and justifiably," said Rebecca Arsenault, Lifelink spokeswoman.

Statistics for how many Southwest Florida residents lost their Medically Needy coverage this past January weren't readily available from the state Department of Children and Families. Last November, 776 individuals from Lee County and 338 people from Collier County were in the program.

The petition asks state lawmakers to revise the Medically Needy share of cost by using a sliding scale formula according to federal poverty guidelines. That would help

The petitioners will collect signatures through the end of December. Supporters can sign it at dialysis centers, transplant hospitals or online at www.floridachain.org.

"The more we get the word out, the better we are going to be," said Bette Luksha, another member of the survivor transplant coalition.

At the same time, Luksha realizes that homeowners' insurance reform and immigration are priority issues next spring for the state Legislature.

"I believe we will be coming in with open minds and other options to the sliding scale (proposal)," Ross said. "I would like to see some hearings, to tell people exactly who we are and how by the third week of the month don't have any money to live on."

Lifelink representatives are backing the petition and have met with elected officials from the Tampa region to inform them of what is happening, said Arsenault, of Lifelink.

"It's heartbreaking," she said. "It flies in the face of everything we try to accomplish here."

•••

A grassroots petition in Florida asking the Legislature to restructure the state's Medically Needy program can be seen and signed at www.floridachain.org.

original story: http://www.naplesnews.com/news/2006/nov/28/petition_asks_legislature_look_medically_needy/