Washington, D.C. – The National Center for Assisted Living (NCAL) thanks Sens. Jeff Bingaman (D-N.M.), Bill Nelson (D-Fla.), and John Rockefeller (D-W.Va.)f or an amendment to America’s Healthy Future Act of 2009 that would eliminate Medicare Part D copayments for low-income seniors receiving assisted living services under Medicaid waivers. The amendment would be effective no sooner than 2012 if enacted.
“NCAL praises Sens. Nelson, Bingaman, and Rockefeller for their amendment included in the revised chairman’s mark of America’s Healthy Future Act of 2009 that would provide Medicare Part D copayment coverage for assisted living residents receiving services through waivers,” says David Kyllo, NCAL’s executive director. “Their leadership is critical to assuring these low-income seniors have continuous access to their medications, which maintain their quality of life and prevent more costly health consequences from occurring.”
The amendment would eliminate copayments for dually eligible beneficiaries—individuals eligible for Medicare and Medicaid—covered under Medicaid 1915, 1932, and 1115 waivers.
When Medicare Part D took effect on Jan. 1, 2006, dually eligible beneficiaries, who previously had medication coverage under Medicaid, were switched to Medicare Part D. Under the Medicare prescription drug program, individuals in institutionalized settings have no Medicare Part D cost sharing responsibilities.
Sens. Nelson and Bingaman are cosponsors of the Home and Community Services Copayment Equity Act of 2009 (S. 534) introduced earlier this year. The bill seeks to eliminate Medicare Part D copayments for dually eligible individuals living in residential care settings, including assisted living.
Studies show that the average assisted living resident takes between eight to 10 medications and Medicare Part D copayments range between one to more than five dollars per prescription, which results in many dual eligible residents quickly exceeding their state monthly personal needs allowance under Medicaid. When residents exceed their allowance, they do not have the means to purchase medications, which may cause some residents to forgo their medications. Without needed medications, they are risking their health and increasing the possibility of a catastrophic health incident. In addition, under Medicare Part D, pharmacies and drug plans are not required to dispense medications to a beneficiary if the individual is unable to pay the assigned copayments.
“Sens. Nelson, Bingaman, and Rockefeller’s amendment is a major step toward fixing this gap in the Medicare prescription drug program. When lawmakers enacted the program, it was intended to offer benefits to all seniors, taking into account their ability to pay no matter where they lived,” says Kyllo. “We look forward to working with Sens. Nelson, Bingaman, and Rockefeller as the health reform package moves through the Senate Finance Committee and ultimately in the final health care reform legislation signed by the President.”
The National Center for Assisted Living (NCAL) represents more than 2,700 not-for-profit and proprietary assisted living and residential care communities dedicated to continuous improvement in the delivery of professional compassionate care and services for the elderly and disabled. NCAL is the assisted living voice of the American Health Care Association.