Friday, November 11, 2005

Medicare Part D Update from THMP (Part I)

I attended the update on Medicare Part D provided by the Texas HIV Medication Program Director, Dwayne Haught, RN, here in Austin yesterday. (He’s been giving a series of these updates, and I recently listed the dates of those I know about here in Texas AIDS Blog.) I requested that the presentation that he is using be placed on the HIV/STD Program’s website, and he directed his staff to try to get that done next week. In the meantime, there are a couple of highlights from his presentation that are important to THMP clients.

First, there are about 1800 THMP clients who will receive assistance in accessing the prescription benefit for Medicare, and these clients will be transitioned out of THMP as soon as possible. These clients are those who are Dual Eligibles (people who are currently receiving both Medicaid and Medicare services), Partial Dual Eligibles (people who receive Medicare services but whose Medicare premiums are paid by Medicaid), and Low Income Subsidy/Extra Help clients (those whose income is below 135% of Federal Poverty Guidelines [FPG] and who receive Extra Help from Medicare in paying their premiums). These groups of THMP clients will end up with no premiums, no deductibles, small (or no) co-pays, and access to a much wider range of medications than is currently available through THMP. They will, it appears, be much better off in terms of their prescription coverage, so there will be no advantage to the client in remaining in THMP.

The deadline for these transitions is rapidly approaching. Dual Eligibles will stop receiving their medications through Medicaid on December 31, 2005, and begin receiving them through Medicare on January 1, 2006. The transition for the others should happen by May 15, 2006. THMP is working to identify these clients and to assist them in making the transition as rapidly as possible.

Second, clients who do not qualify for assistance under these categories should still apply for Extra Help. The reason for this is that applying and being rejected creates documentation that no assistance is available and allows for Ryan White funds to be used for assistance. Since Ryan White funds are “last resort” funds, the client will have to show that other sources of help have been “exhausted.”

There is, however, a bit of a catch involved with the application for Extra Help. There are only two ways to apply. One way is to apply on line by filling out a web-based form and submitting the information electronically. The other is to request a printed form, fill it out, and then mail it back. Printing out the web-based form, filling it out, and mailing it in is not acceptable. (Go figure.) THMP is handing out application forms at its update meetings.

More to come.

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