Washington, D.C. – Today, the National Center for Assisted Living (NCAL) applauded the Senate for including a provision in, “The Patient Protection and Affordable Care Act” that would eliminate Medicare Part D copayments for certain groups of low-income seniors and individuals receiving assisted living services under Medicaid.

Under Section 3309, cost sharing would be eliminated for dual eligibles—individuals eligible for Medicare and Medicaid—covered under 1915c or 1115 waivers, Medicaid managed care plans, and the 1915(i) Medicaid HCB State Plan Option. If enacted, the provision would be effective no sooner than January 1, 2012.

“NCAL thanks the Senate for including this important provision in The Patient Protection and Affordable Care Act. If enacted, this would provide Medicare Part D copayment coverage for assisted living residents and individuals receiving services through Medicaid waivers,” says David Kyllo, NCAL’s executive director. “The Senate’s 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.

“We look forward to working with the Senate on its health reform package as it moves to a floor vote and is ultimately signed by the President,” says Kyllo.

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.

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.

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.