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CONNECTICUT LAWS “WRAP AROUND” MEDICARE PART D

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The Center for Medicare Advocacy and a Connecticut coalition of advocates for older people and people with disabilities worked during two legislative sessions to obtain state funds to fill some of the gaps in drug coverage created by Medicare Part D for Connecticut’s vulnerable residents. The goal of the Coalition was to ensure that Medicare beneficiaries who also have ConnPACE or Medicaid were not worse off after Medicare Part D was implemented. The Coalition sought to maintain the same cost-sharing responsibilities and equal access to drugs for these individuals as for those Medicaid and ConnPACE participants who do not qualify for Medicare.

The Coalition helped key legislators develop An Act Concerning Implementation of the Medicare Part D Program (P.A. 05-2). This legislation was passed unanimously by both the Connecticut Senate and House of Representatives in a special session of the state legislature, and was signed by the Governor on December 1, 2005. The bill created a special fund, known as the Medicare Part D Supplemental Needs Fund, to meet the needs of Connecticut Medicare beneficiaries who are also enrolled in ConnPACE or Medicaid. In May, 2006 the legislature amended the law, making the Part D Fund permanent, but leaving its funding subject to budget appropriations. The legislature initially appropriated $5 million for the fund and has appropriated $5 for each fiscal year since then, an amount advocates expect to fall short of the need. The bill (Senate Bill No.703) was signed into law by the Governor.

The Coalition will continue to work to hold these beneficiaries harmless: to ensure that they have the same access to medications and the same cost-sharing responsibilities as existed prior to the onset of Medicare Part D.  Thus far the legislation goes a long way, but does not completely meet this goal.  In particular, the Connecticut law:

• Covers the Medicare Part D co-pays for dually eligible individuals. 
• Covers, for those on ConnPACE, the actual cost of prescribed drugs above ConnPACE’s $16.25 co-pay. 
• Covers drugs covered by Medicaid and ConnPACE that are not on the individual’s Medicare Part D formulary, provided that the individual makes a good faith effort to utilize the Medicare Part D “Exceptions” process for the drugs.
• Covers the Medicare Part D monthly premiums for  ConnPACE participants.  (Part D premiums for dual eligibles are covered by the Part D low income subsidy.)

 COALITION MEMBERS 

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Copyright © Center for Medicare Advocacy, Inc. 03/31/2008