Medicare plan needs injection of state funds

It took lawmakers 150 minutes earlier this month to introduce, pass and get the governor’s signature on a bill giving 10 percent of the state’s 180,000 Medicare recipients guaranteed payment for a 10-day supply of their prescribed medicines.

The quick $500,000 appropriation – passed unanimously in the Senate and by a 332-20 vote in the House — gave clout to a Jan. 6 gubernatorial executive order to backstop the new federal Medicare Part D drug program, which began on New Year’s Day amid a national wave of criticism and major computer glitches.

State officials replied quickly to the situation in New Hampshire, where reports emerged that elderly and disabled patients were leaving their pharmacies in large numbers without their medications, even vital ones.

“Getting their prescriptions filled is a matter of life and death for some of our citizens,” the governor said. He said implementation of the Medicare drug program has been a “nightmare,” particularly the so-called dual eligibles — people who were already receiving prescription drug coverage through Medicaid.

Geoffrey Souther, who heads the Part D liaison effort for the state, confirmed reports that Medicare randomly assigned Medicaid patients to a private Medicare plan without first considering their medical needs. The approved drug lists, co-pays, premiums and deductibles vary from plan to plan.

Greg Moore, spokesman for HHS, said case managers worked hard to re-enter the 18,000 dual-eligibles into their best private plan. When those folks went to their pharmacies, the computer sometimes failed to recognize the second enrollment. Sometimes it failed to recognize the patient at all. Sometimes it mistook the person for a Medicare patient without Medicaid and charged a much higher co-payment than the correct one.

Lynch ordered Health and Human Services Commissioner John Stephen to tell pharmacies to fill prescriptions for any patient with both a Medicaid and a Medicare card. New Hampshire would recoup the money from the feds or from private Medicare-approved plans, he said.

“Many of our citizens are arriving at their local pharmacies and finding out there is no record of their enrollment in a prescription plan,” Lynch said of the hectic first week of Part D. “They are finding they are being charged unaffordable co-pays for prescription drugs — co-pays much higher than they are supposed to be. Too many of them are leaving their pharmacies without their prescriptions. Even one is too many.”

House and Senate leaders met for hours that first week with Lynch, Stephen and clinicians on the front lines with floundering clients. At that point nobody knew if it would cost $100,000 or $1 million to provide a short-term fix.

“John Stephen needed permission to pay the pharmacies,” said Sen. Bob Clegg, R-Hudson. “Nobody was sure if a thing like this had ever been done before. We skipped covering ourselves and said we’d just do it. Nobody is going to tell us it was a bad idea to get them their insulin or pain meds.”

Rep. Fred King, R-Colebrook, heads the House Finance Committee and voted against Senate Bill 393 — the emergency medication measure — because he thought it was unnecessary. The state, in his opinion, should have taken the funds out of the $43 million it had set aside Jan. 5 to pay Medicare as New Hampshire’s share of Part D.

“Somebody has to pay us back,” King said.

Who foots the bill?

King feared a bigger problem than the 18,000 citizens eligible for the two federal insurance programs.

The other 160,000 Medicare recipients, most of them on fixed incomes, may have faced similar computer glitches. Medicare allowed 42 private insurance companies to offer competing plans, and not all of them went live smoothly. Without a trial run, their software had to mesh with Medicare’s and the state’s.

“This has been a terrible bureaucratic process for the drug stores and people,” King said.

Also opposing SB 393 was Rep. Neil Kurk, R-Weare, who criticized the bill on the House floor, saying the state set aside $10 million in December to bail out the federal fuel assistance program.

“Now we have to spend $500,000 to bail out another federal program,” he said. “Is this going to go on?”

Rep. Steve Vaillancourt, R-Manchester, did some quick math and said the $500,000 amounts to about $30 per recipient.

“I’m wondering how critical this is,” he said.

House Majority Leader Mike O’Neil (R-Hampton) said most of the money would go to the estimated 3,000 people in the toughest shape.

Mike Ventola of the statewide Heritage Case Management agency didn’t wait for the state’s emergency help. He made sure most of his clients stocked up on their meds right after Christmas while their Medicaid cards would still work. Four of them ignored his advice and trusted their new Medicare benefit, but the pharmacies mistakenly rejected them after Jan. 1.

“This is a disaster,” Ventola said. “We put most of our clients into the same plan, but they never got their confirmation letters or cards. Their insurance company has been buried with calls. The recording says to try back at 9 p.m. or midnight. The pharmacy was going to charge one of my people $338 for some pain medication. She went two days without it.”

Rep. Bernie Buzzell, D-Berlin, a former case manager, said some patients have 15 and 20 medications.

“A lot of these people have no case manager,” he said. “They don’t have cars either. The burden is really on their families now, if they have them nearby. Some people could be suffering dearly, and there’s a trickle-down effect. Eventually it will cost local taxpayers.”

Rep. Jim Pilliod, R-Belmont, a physician, has followed the Part D issue since the summer, when he predicted chaos come January. He was horrified to learn the feds blindly picked plans for Medicaid recipients.

“That’s ridiculous,” Pilliod said. “It was a serious mistake to let just anybody create a health plan, and it takes computer access to enroll someone. The elderly don’t know what to pick, and most don’t have computers. When you have 42 of these plans, some are going to be substandard.”

Wealthier towns like Amherst and Londonderry may have escaped the worst of the declared crisis. They have a small percentage of low-income and frail senior citizens who qualify for both federal insurance programs.

Londonderry senior affairs director Sara Landry said two volunteers for the Medicare Part D counseling program did yeoman’s work getting elders to sign up at the senior center. Few of them were on Medicaid, the focus of the computer problems.

“We’ve gotten good feedback from people they met with,” Landry said. “There was an initial backlog, but nobody has called to say they have problems. We don’t have too many really low-income seniors in town, and my guess is most of them live with sons or daughters who helped them. Of all the holiday food baskets we sent out over the holidays, maybe eight or 10 went to the elderly. You don’t have any Medicaid recipients in all these new senior housing subdivisions. They can’t afford it.”

Rep. Tom Donovan, D&R-Claremont, is a case management administrator. According to him, the federal government randomly assigned Medicaid recipients to Medicare plans because “they didn’t want to give the appearance of favoring one plan. It was to avoid being sued.”

The returns won’t be in for a while, but many seniors are sitting out the Part D program. One of them is Representative King.

“I have an excellent retirement plan,” the Colebrook lawmaker said. “It would be foolish for me to change.”