Prescription coverage revised

Medicaid legislation
alters drug funding
for older Missourians.
Monday, April 11, 2005 | 12:00 a.m. CDT; updated 10:36 p.m. CDT, Friday, July 18, 2008

JEFFERSON CITY — Tucked into legislation cutting tens of thousands of people from the state’s Medicaid rolls is a provision reconfiguring a program that provides prescription drug benefits to older people.

Missouri’s SenioRx program provides helps with drug costs to more than 17,000 Missourians age 65 and older who have too much money to qualify for the government-run Medicaid program for the poor but not enough to afford private prescription coverage. But the state is changing its program to mesh with a federal prescription drug benefit that is part of the Medicare program and is set to take effect in January.

“It was imperative that we structure a plan that would fit hand in glove with the Medicare (prescription drug) program as a wraparound benefit,” said Eric Feltner, deputy lieutenant governor and official advocate for older people.

The Medicaid legislation containing the state’s revamped senior drug program won final legislative approval Thursday, and Gov. Matt Blunt plans to sign it into law. The drug program, overshadowed by the Medicaid cuts, received virtually no debate.

The federal Medicare program provides health care to people age 65 and older, regardless of their income levels. The state-run Medicaid program applies only to low-income people, providing enhanced coverage to seniors also on Medicare.

The state’s SenioRx program pays some drug costs for people with eligible incomes: less than $12,000 for one person. Participants must pay a deductible, which varies based on their income, and 40 percent of their drug costs.

Under the new federal Medicare prescription benefit, seniors will pay a monthly premium plus the first $250 in annual prescription costs, and Medicare will cover 75 percent of the next $2,000. There will be no coverage for a person’s annual prescription expenses between $2,250 and $5,100. Medicare then will cover 95 percent of costs above $5,100.

Missouri lawmakers considered a proposal in 2004 to basically fill in that gap in the federal plan, but the measure failed. State lawmakers thought they had to do something this year because the SenioRx program expires in mid-December.

This year’s legislation “will be very beneficial for seniors that qualify for Medicare prescription drug relief,” said Jo Walker of Marshfield, state president of the Silver Haired Legislature.

This year’s bill leaves many details to be worked out later, though it does say the plan should focus first on those eligible for Medicare and Medicaid, then on those with household incomes under 150 percent of the federal poverty level, or $14,355, with limited assets. If money were available, people earning more also could participate.

The revised state drug program for seniors, dubbed Missouri Rx, will be run by the Department of Social Services. Its intent is still to cover the gap in prescription drug coverage under the federal plan, but just how much the benefit is and what costs seniors must pick up aren’t spelled out in the bill. The department will determine those details.

Walker said that covering more seniors would be ideal, but that she understands the state’s financial constraints.

“We also have to look at being realistic,” she said. “Certainly that would be beneficial for seniors if it could cover all of those, but we can cover benefits for the needy or near-needy.”

The goal is to fund the program largely through prescription drug rebates that the state receives from drug companies for allowing them to offer their products under the state’s plan.

The plan’s cost, and how many people would be enrolled, remain undetermined. But Missouri has more than 160,000 people on both Medicare and Medicaid, so the program could have 10 times the enrollment of the current one, though benefits to each person could be lower as the federal plan would cover many costs.

The department will have several months to figure out how to structure the program, with the help of an advisory commission that includes Lt. Gov. Peter Kinder.

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