014-2006 Gov Extends Medi-CalMedicare Emergency Drug Coverage

CDCAN
CALIFORNIA DISABILITY COMMUNITY ACTION NETWORK
DISABILITY RIGHTS NEWS REPORT
#0014-2006 January 27, 2006 Early Friday
Advocacy Without Borders:
Connecting people with disabilities & seniors to rights and unified action
1225 8th Street Suite 480 - Sacramento, CA 95814 916/446-0013 Fax: 916/446-0026
Marty Omoto - director email: martyomoto@rcip.com website: www.cdcan.us

MEDICARE PART D DRUG CRISIS
* Governor Extends Emergency Drug Coverage
* Coverage Now Expires Late on Feb 11
* Reports Of Continued Problems As Crisis Goes On
* Major Impact To People With Disabilities/Seniors

SACRAMENTO - Gov. Arnold Schwarzenegger, as expected, extended on Thursday (January 26) the emergency drug coverage program for persons with developmental and other disabilities and low-income seniors who are eligible for both Medi-Cal and Medicare but were unable to obtain their medications when the new federal Medicare drug program took effect January 1. The Governor extended the temporary emergency drug coverage program for another 15 days or until February 11, at 11:59 PM. .[Note: Please see latest revised Medi-Cal revised bulletin (available from the Medi-Cal program site at Medi-Cal.ca.gov or go to the CDCAN website at www.cdcan.us]

The State estimates that at least 200,000 of the State's over 1 million persons with developmental or other disabilities and seniors who are dually eligible for both Medi-Cal and Medicare, have been impacted by the nationwide crisis. As of January 25, 2006, Wednesday late evening at 11:59 PM, the California Department of Health Services reported that the State had filled 141,211 prescriptions at a cost of $11.4 million under this emergency plan. The federal government said this week that it will fully reimburse the 20 states, including California, that have put in place emergency drug coverage programs. California's Medi-Cal Director Stan Rosenstein, who spoke to several hundred persons with disabilities and seniors participating in the January 26 CDCAN Disability Rights Townhall Telemeeting, was appointed by the Governor to be a lead negotiator with the federal government to ensure states receive full payment.

"While the federal government has stepped up and is working to fix problems with their prescription drug program, Californians are still having trouble accessing the critical medications they need to stay alive," said Gov. Schwarzenegger. "Vulnerable Californians need our help, that's why I am taking the action necessary to ensure low-income seniors and persons with disabilities walk out of the pharmacy with the drugs they need. We will continue to work with the federal government to ensure all the problems in this system are fixed and that states are made whole for the costs of protecting our residents."

AB 132 Legislation Gives Governor Authority To Extend Emergency Program
The emergency legislation, passed by the Legislature January 20 and signed by the Governor on January 21, does the following::
* Effective January 12, 2006, authorizes Governor Schwarzenegger and the California Department of Health Services to be the payor of last resort for persons with disabilities and seniors who are eligible for both Medi-Cal and Medicare but were unable to get their medications through the Medicare program to ensure no dual eligible leave the pharmacy without their needed prescription drugs.
* Establishes an initial 15-day emergency program, which originally began on January 12 and was set to end at 11:59 PM January 27. 2006 (Thursday). The bill gives the Governor the authority to extend that further by another 15 days (to 11:59 PM, February 11, 2006 Saturday evening), which he did on Thursday afternoon (January 26).
* Allocates $150 million dollars from the state's general fund to fund this emergency program for up to 30 days.
* Provides the California Department of Health Services the authority to seek reimbursement from the federal government and the Medicare Part D plans for the cost of this emergency action.
* To receive reimbursement under this emergency program, a pharmacy must certify that it was either unable to obtain necessary information from Medicare to submit a claim, its claim was incorrectly denied or that the beneficiary's deductible or co-payment was higher than the $1 to $5 amount established by Medicare.

Tens of Thousands of People With Disabilities and Seniors Were Unable To Get Medications
* At the special townhall telemeeting organized by CDCAN a week ago on Thursday, January 19, David Topper, Assistant Secretary of the California Health and Human Service Agency estimated that of the 1 million Californians with disabilities or who are elderly, over 200,000 were unable to get their needed medications under the new federal Medicare prescription drug program that went into effect on January 1.
* Over 250 people with disabilities and seniors, their families, community organizations and other advocates participated in the townhall telemeeting and also heard updates from officials from the Department of Health Services' Medi-Cal program and the Department of Developmental Services, which oversees the 21 non-profit regional centers who fund services for children and adults with developmental disabilities. Several hundred more participated in the January 26 CDCAN townhall telemeeting that featured Stan Rosenstein, head of the state's Medi-Cal program.
* Topper said to the CDCAN Disability RIghts Townhal Telemeeting that the transition of these individuals to Medicare drug plans resulted in an error rate of 20%.
* As of January 19 11:59 PM, the State had filled 77,514 prescriptions under the emergency drug plan.
* As of January 25, 2006, Wednesday late evening at 11:59 PM, the State had filled 141,211 prescriptions at a cost of $11.4 million

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The California Disability Community Action Network is a non-partisan link to thousands of Californians with developmental and other disabilities, people with traumatic brain and other injures, seniors and their families, community organizations and providers, direct care and other workers, and other advocates. These action alerts and news reports is for all of them. If you would like to get on this distribution (and conversely, get off of it) please send an email with that request to: martyomoto@rcip.com OR sign up via the NEW CDCAN website at www.cdcan.us Sharing information is part of our organizing effort. Please feel free to forward or copy this (attribution is nice). We're all in this together!